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September 17, 2026Current HIV/AIDS ReportsOpen Access

Pitavastatin cuts MACE ~35% versus control in low-to-moderate risk patients with HIV.

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Why the study?

Does statin therapy reduce major adverse cardiovascular events in people living with HIV?

Population

People living with HIV aged 40–75 years receiving antiretroviral therapy and at low-to-moderate estimated…

Design

Review

Key result

Pitavastatin reduced the incidence of major adverse cardiovascular events (HR 0.65) compared to control in people living with HIV aged 40-75 years at low-to-moderate cardiovascular risk.

Authors

PFPaolo FuscoFMFrancesco De MariaBTBruno Tassone

Discussion

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Overview

Supports statin use for primary prevention in HIV patients aged 40-75; leaves optimal strategies outside this range and for non-statins open.

Key Points

  • Evaluate primary cardiovascular prevention strategies, specifically statin therapy and risk stratification tools, for people living with HIV in light of the REPRIEVE trial and updated clinical guidelines.
  • Reviewed clinical trial evidence from the REPRIEVE trial alongside the 2026 ACC/AHA multisociety dyslipidemia guidelines.
  • Synthesized cohort studies and literature addressing conventional cardiovascular risk calculators, imaging modalities, and non-statin lipid-lowering therapies in people living with HIV.
  • Pitavastatin significantly reduced major adverse cardiovascular events in individuals aged 40–75 years on antiretroviral therapy with low-to-moderate baseline risk, though absolute benefit varied widely by baseline risk.
  • Conventional risk prediction algorithms demonstrate variable predictive performance in people living with HIV, with limited high-quality evidence supporting imaging-guided prevention or non-statin agents.
  • Individuals younger than 40 experience higher relative cardiovascular risk despite low absolute event rates, while treatment decisions for those outside the 40–75 age range require integrating general-population data, comorbidities, and drug interactions.

Structured PICO

Does statin therapy reduce major adverse cardiovascular events in people living with HIV?

P
Population
7,769 people living with HIV aged 40-75 years on stable antiretroviral therapy with low-to-moderate cardiovascular risk, followed for a median of 5.1 years in the REPRIEVE trial.
I
Intervention
Statin therapy (pitavastatin)
O
Outcome
Major adverse cardiovascular eventshard clinical

Main Result

Hazard Ratio: 0.65 (95% CI 0.48–0.9)

Absolute Event Rate: 4.81% vs 7.32%

Statin therapy is an evidence-based component of primary cardiovascular prevention in people with HIV aged 40-75 years, but decisions outside this age range require individualized risk-benefit assessment.

Limitations

  • Relatively low baseline cardiovascular risk of the REPRIEVE study population
  • Need for longer-term follow-up to fully assess durability of benefit
  • Lack of direct randomized evidence for people living with HIV younger than 40 or older than 75 years
  • No adequately powered randomized trial has demonstrated that non-statin lipid-lowering therapy reduces cardiovascular events specifically in this population

Cite This Study

Fusco et al. (2026) conducted a review in HIV (n=7,769). Pitavastatin vs. Control was evaluated on Major adverse cardiovascular events (MACE) (HR 0.65, 95% CI 0.48-0.90). Pitavastatin reduced the incidence of major adverse cardiovascular events (HR 0.65) compared to control in people living with HIV aged 40-75 years at low-to-moderate cardiovascular risk.

synapsesocial.com/papers/6aabb7e75f706d05830e72dehttps://doi.org/10.1007/s11904-026-00797-w
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