The British HIV Association (BHIVA) now recommends that all people living with HIV ages 40 and older should be offered a daily statin medication to reduce their risk of cardiovascular disease (CVD).

As people with HIV live longer, CVD has become a leading cause of morbidity and mortality. Statins reduce LDL cholesterol levels and may have additional benefits, including reduced inflammation and blood clotting. These medications generally are not recommended for people with low CVD risk scores unless they have certain comorbidities, but scoring systems developed for the general population tend to underestimate the risk for people living with HIV.

The new guidance, released in November, is supported by findings from the large REPRIEVE trial, which showed that HIV-positive people with low to moderate CVD risk reduced their likelihood of heart attacks, strokes and other major cardiovascular events by 35% if they took daily pitavastatin.

The BHIVA guidelines recommend baseline lipid assessments and optimization of antiretroviral therapy. HIV-positive people ages 40 and older should be offered a statin regardless of their lipid profiles or estimated CVD risk. Pitavastatin (Livalo) is preferred, but atorvastatin (Lipitor) can be used as an alternative. The authors emphasize that statins should be part of a holistic heart-healthy lifestyle that includes smoking cessation, a healthy diet, exercise and weight management.