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HHS Panel Urges Statin Therapy for Adults with HIV at Elevated Cardiovascular Risk
- A specialized panel formed by the U.S. Department of Health and Human Services recommends statin therapy for adults with HIV at increased cardiovascular risk.
- The recommendations are based on the REPRIEVE study, which showed a 36% reduction in major cardiovascular events with pitavastatin use in HIV patients aged 40-75.
- Increased cardiovascular risk in PWH is attributed to factors like chronic inflammation, residual viral replication, and antiretroviral therapy side effects.
- Moderate-intensity statins like pitavastatin, atorvastatin, and rosuvastatin are suggested for primary prevention in HIV patients with a 10-year ASCVD risk score of 5% or higher.
- Initiation of statin therapy should be individualized based on the patient's HIV-specific risk factors and comorbidities, including inflammation biomarkers and ART history.
- The panel highlights the safety and minimal drug interactions of moderate-intensity statins in HIV patients, particularly recommending pitavastatin for its reduced interaction risk.
- Guidelines emphasize the need for continued research on absolute cardiovascular risk assessment and nonischemic cardiac manifestations in HIV, like cardiomyopathies and arrhythmias.
- A collaborative effort involving key medical associations, the guidelines aim to integrate cardiology and HIV care to optimize statin use and reduce cardiovascular morbidity in PWH.
- Future directions include studies on statins' effects beyond lipid modulation in HIV, advanced imaging for risk stratification, and promoting equitable statin uptake through education and patient engagement.
- The updated guidelines mark a critical shift in HIV care towards managing comorbidities like ASCVD, reflecting a holistic approach to improving health outcomes in the HIV population.
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