Pitavastatin to Prevent Cardiovascular Disease in HIV Infection

The phase 3 REPRIEVE trial evaluated pitavastatin for primary prevention of cardiovascular disease (CVD) in 7769 adults with HIV infection on stable antiretroviral therapy and low-to-moderate CVD risk. Participants were randomized to 4 mg daily pitavastatin or placebo and followed for a median of 5.1 years. The trial was stopped early due to efficacy: pitavastatin reduced major adverse cardiovascular events (MACE), including death, MI, stroke, revascularization, by 35% (HR 0.65; P=0.002). LDL cholesterol fell from 108 to 74 mg/dL on pitavastatin with durability over time. Adverse events were infrequent; muscle symptoms occurred in 2.3% of pitavastatin recipients vs. 1.4% placebo, and incident diabetes was slightly higher (5.3% vs. 4.0%). Benefits were consistent across sex, age, race, CD4 count, HIV viral load, and global regions. Findings support pitavastatin as a safe, effective strategy to reduce CVD events in HIV patients with low or moderate baseline risk.

The phase 3 REPRIEVE trial evaluated pitavastatin for primary prevention of cardiovascular disease (CVD) in 7769 adults with HIV infection on stable antiretroviral therapy and low-to-moderate CVD risk. Participants were randomized to 4 mg daily pitavastatin or placebo and followed for a median of 5.1 years. The trial was stopped early due to efficacy: pitavastatin reduced major adverse cardiovascular events (MACE), including death, MI, stroke, revascularization, by 35% (HR 0.65; P=0.002). LDL cholesterol fell from 108 to 74 mg/dL on pitavastatin with durability over time. Adverse events were infrequent; muscle symptoms occurred in 2.3% of pitavastatin recipients vs. 1.4% placebo, and incident diabetes was slightly higher (5.3% vs. 4.0%). Benefits were consistent across sex, age, race, CD4 count, HIV viral load, and global regions. Findings support pitavastatin as a safe, effective strategy to reduce CVD events in HIV patients with low or moderate baseline risk.