Balancing polypharmacy and comorbidity management: cardiovascular health

Area of Science:

• Public Health
• Infectious Diseases
• Cardiology

Background:

• Aging people with HIV (PWH) face increased risks of chronic diseases, necessitating management alongside antiretroviral therapy (ART).
• Cardiovascular disease (CVD) is a significant concern for PWH, requiring effective prevention strategies.
• Polypharmacy presents unique challenges in managing chronic conditions for PWH.

Purpose of the Study:

• To review the role of statin therapy in preventing CVD among PWH.
• To discuss balancing chronic disease management with antiretroviral therapy (ART) and polypharmacy.
• To provide guidance on initiating statin therapy for primary CVD prevention in PWH.

Main Methods:

• Review of recent clinical trial data, including the REPRIEVE trial.
• Analysis of current guidelines from the Department of Health and Human Services (HHS).
• Consideration of drug interactions and polypharmacy in PWH.

Main Results:

• The REPRIEVE trial showed statin therapy significantly reduces CVD events in PWH at low to moderate risk.
• HHS now recommends statin therapy for primary CVD prevention in PWH aged 40-75 years.
• Statin initiation should align with established CVD prevention guidelines, accounting for polypharmacy.

Conclusions:

• Statin therapy is recommended for primary CVD prevention in PWH aged 40-75 years.
• Polypharmacy must be carefully considered for all aging PWH.
• Effective management of chronic diseases is crucial for reducing morbidity and mortality and promoting healthy aging in PWH.