No evidence of pitavastatin effect on muscle area or density among people with HIV

Skeletal muscle area and muscle density are key determinants of physical function and typically decline with increasing age. Statins have well known musculoskeletal effects but whether statins impact muscle area or muscle density is not well established, especially in the setting of randomized treatment.

REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in people with HIV (PWH). Thoracic paraspinal, pectoralis, and infraspinatus muscle area and muscle density were assessed among Mechanistic Substudy participants with CT at baseline and month 24.

Of 804 substudy participants, 510 remained on study treatment and had imaging at baseline and month 24. Median age was 51 years; 17% were natal female, 35% Black, and 27% Hispanic. There were no apparent changes in muscle measures from baseline to month 24 within the treatment groups. The estimated treatment group differences in baseline-adjusted month 24 outcomes were minimal [within 0.5 cm 2 /m for height-adjusted MA with 95% confidence interval (95% CI) bounds within <1 cm 2 /m, and within 1 Hounsfield units (HU) for MD with 95% CI bounds within <3 HU; all P  > 0.2]. Findings were generally consistent in subgroup analyses.

Pitavastatin was associated with no apparent change in muscle measures over 24 months, and with no evidence of detrimental effect among PWH.