Recommendations released on statin therapy for people with HIV
The guidance from a panel of the U.S. Department of Health and Human Services addresses primary prevention of atherosclerotic cardiovascular disease in patients ages 40 to 75 years and younger than age 40 years.
People with HIV who are ages 40 to 75 years and at intermediate risk for atherosclerotic cardiovascular disease (ASCVD) over 10 years should begin at least moderate-intensity statin therapy, according to new recommendations from the U.S. Department of Health and Human Services Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.
The recommendations, which were released online Feb. 27, were developed in collaboration with representatives from the American College of Cardiology (ACC), the American Heart Association (AHA), and the HIV Medicine Association.
Specific therapy recommendations for those ages 40 to 75 years at moderate 10-year risk (5% to <20%) include pitavastatin, 4 mg once daily; atorvastatin, 20 mg once daily; and rosuvastatin, 10 mg once daily, the statement said. The panel favors starting at least moderate-intensity statin therapy with the same drug regimens in patients ages 40 to 75 years with 10-year risk estimates below 5% but notes that the absolute benefit is modest in this population and that the presence or absence of HIV-related factors that can increase ASCVD risk should be considered.
In patients with HIV who are younger than age 40 years, data are insufficient to recommend for or against statin therapy as primary prevention of ASCVD, the panel said. The panel noted that 2018 joint multisociety guidelines from the AHA, ACC, and others recommend lifestyle modifications for people younger than age 40 years, with statin therapy considered only in select populations.
Key considerations include that coadministration of certain statins and antiretroviral drugs may lead to significant drug-drug interactions that require adjusting the statin dose, switching to another statin, or increasing monitoring for statin-related adverse effects, the panel said. It also noted that statin therapy should not be started in pregnant patients who are at low to intermediate ASCVD risk until after pregnancy and should be discontinued if a person with HIV becomes pregnant. Patients should not breastfeed while taking statins, the panel said.
The guidelines include a table with specific recommendations for pitavastatin, atorvastatin, and rosuvastatin when used with different antiretroviral drugs based on their potential for drug-drug interactions.