In cohort studies, compared to the general population or controls without HIV, people living with HIV are at greater risk of atherosclerotic cardiovascular disease (CVD). There are established national guidelines for the primary prevention of CVD with statins. Because general population CVD risk calculators may underestimate risk in people living with HIV, HIV is considered an additional CVD risk factor, but there are no specific recommendations for people living with HIV. REPRIEVE, the largest randomised trial undertaken in people living with HIV, demonstrated a significant reduction in major adverse cardiovascular events in participants randomly assigned to pitavastatin 4 mg daily as compared to those receiving placebo. Here we provide rapid guidance on the implications of the REPRIEVE study for clinical practice. Statins are an effective tool to reduce CVD risk but should be considered in the context of holistic lifestyle optimisation with a particular focus on smoking cessation. While current guidelines in primary prevention focus on estimated 10-year CVD risk, the goal of this guidance is to attenuate lifetime not just 10-year risk.
This guidance was released in November 2023 and updated in March 2024, and will be reviewed in March 2025.
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Downloads
BHIVA guidance on the use of statins for primary prevention of cardiovascular disease in people with HIV (updated March 2024)
BHIVA and HIVPA rapid guidance on statins for primary prevention of CVD: suggested text for GP communication (January 2024)