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May 27, 2025 — In a landmark move, a panel of leading U.S. health organizations has recommended statin therapy for adults living with HIV who are at risk for cardiovascular disease (CVD). The guidance, issued by the U.S. Department of Health and Human Services (HHS) Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, was developed in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), and the HIV Medicine Association (HIVMA).
Groundbreaking Evidence from the REPRIEVE Study
The recommendations are based on findings from the REPRIEVE study, a large, global, Phase III randomized controlled trial. The study investigated the effects of oral pitavastatin versus placebo in preventing atherosclerotic cardiovascular disease (ASCVD) among people with HIV aged 40 to 75 years who were at low to intermediate risk for CVD.
Results showed that pitavastatin reduced the risk of major adverse cardiovascular events (MACE) by 36% compared to placebo. This significant reduction prompted the panel to recommend moderate-intensity statin therapy as a primary prevention strategy for people with HIV (PWH) in this age and risk group.
Key Recommendations
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For PWH aged 40–75 years with low to intermediate 10-year ASCVD risk: Initiate moderate-intensity statin therapy.
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For PWH with a 10-year ASCVD risk score of 5% or higher: Strong recommendation to start statin therapy.
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For PWH with a risk score below 5%: Statin therapy is favored, but decisions should involve patient–clinician discussions, considering HIV-related factors that may elevate risk.
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For PWH under 40 years: Decisions should be individualized, based on risk factors and family history.
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Recommended statins and dosages: Pitavastatin 4 mg daily, atorvastatin 20 mg daily, or rosuvastatin 10 mg daily.
Looking Ahead
The panel emphasized the need for further research to better understand the absolute risk for ASCVD and other cardiovascular conditions in people with HIV. As people with HIV are living longer, they face increased risks for aging-related diseases, making preventive strategies like statin therapy increasingly important.
The full recommendations are published in the Annals of Internal Medicine.
Disclaimer:
This news article summarizes recent medical guidelines and research findings. It is intended for informational purposes only and should not be taken as medical advice. Individuals should consult their healthcare provider before making any changes to their medication or treatment plan. For more details, refer to the official publication in the Annals of Internal Medicine and consult your healthcare professional.
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