{"id":46628,"date":"2023-12-01T07:22:39","date_gmt":"2023-12-01T07:22:39","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=46628"},"modified":"2024-04-10T22:12:59","modified_gmt":"2024-04-10T22:12:59","slug":"uk-hiv-guidelines-recommends-a-statin-for-people-older-than-40","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/46628","title":{"rendered":"HIV guidelines recommend a statin for all people older than 40: new BHIVA document"},"content":{"rendered":"<div>\n<p class=\"HTBsubhead2articletitle\"><em><strong>Note: these guidelines were revised in March 2024 and the references link to the updated version.<\/strong><\/em><\/p>\n<p class=\"HTBsubhead2articletitle\"><strong>Simon Collins, HIV i-Base<\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">On 21 November 2023, BHIVA published rapid guidance relating to the use of statins for people living with HIV. [1]<\/span><\/strong><\/p>\n<\/div>\n<p><span lang=\"EN-US\">The 8-page document is in response to results from the REPRIEVE study published earlier this year that were also presented at the IAS and EACS conferences. [2]<\/span><\/p>\n<p>Other evidence is also reviewed.<\/p>\n<p>REPRIEVE showed that people at low risk of major cardiovascular events (MACE) who were randomised to daily pitavastatin had a significant reduction in MACE compared to daily placebo.<\/p>\n<p>The BHIVA document interprets the results from REPRIEVE in order to reduce overall lifetime risk of cardiovascular events, rather than just to reduce the 10-year risk.<\/p>\n<h2>Recommendations<\/h2>\n<p>The guideline includes four graded recommendations supported by evidence.<\/p>\n<ul>\n<li>That all people living with HIV aged 40 years or older should be offered a statin for primary prevention of CVD irrespective of lipid profile or estimated CVD risk (Grade 1B).<\/li>\n<li>First-line choice for primary prevention should be pitavastatin 4 mg daily when it becomes available in the UK (Grade 2A).<\/li>\n<li>That atorvastatin 20 mg daily can be used as an alternative (Grade 2B).<\/li>\n<li>That a family history of high cholesterol should be excluded when assessing all people with total cholesterol &gt; 7.5 mmol\/L without clear cause or a personal\/immediate family history of coronary artery disease below the age of 60 years (Grade 1C).<\/li>\n<li>To optimise ART in people at high risk of CVD in line with BHIVA treatment guidelines (Grade 1C).<\/li>\n<\/ul>\n<p>Seven additional recommendations are graded as a\u00a0Good Practice Point (GPP).<\/p>\n<ul>\n<li>That CVD risk assessment and discussion about pharmacological primary prevention is combined with a holistic approach to lifestyle modifications including smoking cessation and dietary advice. People needing further support should be signposted to or referred for appropriate multidisciplinary support (GPP).<\/li>\n<li>That CVD risk is assessed using tools recommended by BHIVA monitoring and national guidelines (GPP).<\/li>\n<li>All people living with HIV should have a baseline lipid assessment (GPP).<\/li>\n<li>That people living with HIV aged 40 years or older with an estimated 10-year CVD risk of 5% or greater are prioritised for primary prevention with a statin (GPP).<\/li>\n<li>That people currently on a low-intensity statin should switch to one of moderate intensity if clinically appropriate and tolerated (GPP).<\/li>\n<li>To offer an alternative lipid-lowering drug in line with national guidelines for people unable to tolerate a statin (GPP).<\/li>\n<li>That best practice for primary prevention is for statins to be prescribed and monitored in primary care (GPP).<\/li>\n<\/ul>\n<p>Please see the full document for detailed discussion of the issues and evidence that supports these recommendations.<\/p>\n<div>\n<p class=\"HTBBODYtext\">References<\/p>\n<\/div>\n<div>\n<ol>\n<li class=\"HTBBODYtext\"><span lang=\"EN-US\">BHIVA. Rapid guidance on the use of statins for primary prevention of cardiovascular disease in people living with HIV. 21 November 2023, updated March 2024.<br \/>\n<\/span><a href=\"https:\/\/www.bhiva.org\/BHIVA-rapid-guidance-on-the-use-of-statins-for-primary-prevention-of-cardiovascular-disease\">https:\/\/www.bhiva.org\/BHIVA-rapid-guidance-on-the-use-of-statins-for-primary-prevention-of-cardiovascular-disease<\/a><br \/>\n<a href=\"https:\/\/www.bhiva.org\/file\/655cdf1d7dcb1\/BHIVA-rapid-guidance-on-the-use-of-statins.pd\" rel=\"noopener\">https:\/\/www.bhiva.org\/file\/655cdf1d7dcb1\/BHIVA-rapid-guidance-on-the-use-of-statins.pd<\/a>f\u00a0 (PDF)<\/li>\n<li class=\"HTBBODYtext\">Grinspoon SK et al. Pitavastatin to prevent cardiovascular disease in HIV infection. N Engl J Med 2023; 389: 687\u2013699.<br \/>\n<a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2304146\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2304146<\/a><\/li>\n<li class=\"HTBBODYtext\">REPRIEVE study: statin benefits people living with HIV at low to moderate CVD risk. HTB (1 August 2023).<br \/>\n<a href=\"https:\/\/i-base.info\/htb\/45808\">https:\/\/i-base.info\/htb\/45808<\/a><\/li>\n<\/ol>\n<p><em>This report was first posted on 21 November 2023,<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Note: these guidelines were revised in March 2024 and the references link to the updated version. Simon Collins, HIV i-Base On 21 November 2023, BHIVA published rapid guidance relating to the use of statins for people living with HIV. [1] &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23,31],"tags":[],"class_list":["post-46628","post","type-post","status-publish","format-standard","hentry","category-guidelines","category-opportunistic-infections-coinfections-and-complications"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46628","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=46628"}],"version-history":[{"count":14,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46628\/revisions"}],"predecessor-version":[{"id":47636,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46628\/revisions\/47636"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=46628"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=46628"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=46628"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}