Panel Recommends Statin Therapy for Adults with HIV at Elevated Cardiovascular Risk

In May 2025, a significant update was made in the management of cardiovascular health among people with HIV (PWH). The U.S. Department of Health and Human Services, in collaboration with leading medical organizations such as the American College of Cardiology, the American Heart Association, and the HIV Medicine Association, released new guidelines recommending the use of statins for primary prevention of cardiovascular disease in PWH.

These recommendations are primarily based on the findings from the REPRIEVE trial, a large-scale global study that evaluated the impact of statin therapy in PWH aged 40 to 75 with low to intermediate 10-year ASCVD risk. The trial showed that individuals taking pitavastatin experienced a 36% reduction in major adverse cardiovascular events (MACE), reinforcing the protective role of statins in this population.

The panel advises moderate-intensity statin therapy for PWH aged 40 to 75 at low to intermediate cardiovascular risk, particularly emphasizing initiation when the 10-year ASCVD risk score is 5% or higher. For individuals with a risk score below 5%, clinicians are encouraged to engage in personalized risk discussions, considering HIV-related factors that may elevate cardiovascular risk.

For younger PWH under 40, the decision to start statin treatment should be tailored based on individual risk factors and family history. The recommended statins include pitavastatin at 4 mg daily, atorvastatin at 20 mg daily, or rosuvastatin at 10 mg daily.

Experts emphasize the need for ongoing research to better understand the specific cardiovascular risks faced by people with HIV and to refine prevention strategies accordingly.

This new guidance aims to improve cardiovascular outcomes in PWH, a group increasingly affected by aging-related diseases, by integrating statin therapy into their preventative care plans.