HIV and Cardiovascular Disease — An Ounce of Prevention

   This editorial evaluates cardiovascular disease (CVD) risk among people living with HIV, who face up to twice the risk of CVD compared to those without HIV—despite viral suppression. Traditional risk calculators often underestimate this risk. The REPRIEVE trial demonstrated that pitavastatin reduced major cardiovascular events in this population, even in those considered low to moderate risk. The editorial applauds inclusive trial design, though notes limited data among participants with comorbid conditions like hepatitis C or substance use. It explores mechanisms of risk including systemic inflammation and LDL cholesterol, comparing REPRIEVE to JUPITER and other statin trials. The piece calls for broader preventive strategies beyond statin therapy, including behavioral risk modification and potential immune-modulating treatments, to address unrepresented CVD drivers such as depression, alcohol use, and drug use.

   This editorial evaluates cardiovascular disease (CVD) risk among people living with HIV, who face up to twice the risk of CVD compared to those without HIV—despite viral suppression. Traditional risk calculators often underestimate this risk. The REPRIEVE trial demonstrated that pitavastatin reduced major cardiovascular events in this population, even in those considered low to moderate risk. The editorial applauds inclusive trial design, though notes limited data among participants with comorbid conditions like hepatitis C or substance use. It explores mechanisms of risk including systemic inflammation and LDL cholesterol, comparing REPRIEVE to JUPITER and other statin trials. The piece calls for broader preventive strategies beyond statin therapy, including behavioral risk modification and potential immune-modulating treatments, to address unrepresented CVD drivers such as depression, alcohol use, and drug use.