Prevention and treatment of cardiovascular disease in HIV: practical insights in an evolving field

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• People with HIV (PWH) exhibit a significantly higher risk (approx. 50%) of cardiovascular disease (CVD) compared to the general population.
• HIV-associated CVD pathogenesis is evolving with advancements in antiretroviral therapy (ART) and HIV management.
• Elevated CVD risk in PWH is influenced by factors like sustained viral load, poor CD4+ T-cell recovery, and hepatitis C coinfection.

Purpose of the Study:

• To summarize the current understanding of cardiovascular disease (CVD) in people with HIV (PWH).
• To highlight recent findings on CVD risk reduction strategies in PWH.
• To identify areas for future research in managing CVD in the PWH population.

Main Methods:

• Review of epidemiologic data from multiple cohorts examining CVD risk in PWH.
• Analysis of findings from the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study.
• Discussion of ongoing investigations into non-lipid-lowering therapies for CVD risk reduction.

Main Results:

• The REPRIEVE study demonstrated a 35% relative risk reduction in atherosclerotic CVD for PWH on pitavastatin, exceeding reductions seen with similar statins in the general population.
• Certain antiretroviral drugs and HIV-related factors (e.g., viral load, CD4 count, coinfections) differentially impact CVD risk.
• Non-lipid interventions, including antithrombotic and inflammation-modulating therapies, are under active investigation.

Conclusions:

• Statins show significant efficacy in reducing atherosclerotic CVD risk in PWH, particularly in low-to-moderate risk groups.
• Further research is needed to explore the effectiveness of high-intensity statins and secondary prevention strategies in PWH.
• Comprehensive management of CVD in PWH requires continued investigation into both lipid-lowering and non-lipid-based therapeutic approaches.