The REPRIEVE trial: Developing a cardiovascular disease prevention strategy for people living with HIV

SY06

Symposium

Track B - Clinical science

CME accreditation

Plaza Auditorium/Channel 4

24 July 14:45 - 15:45

The global burden of HIV-associated cardiovascular disease among people living with HIV has tripled over the past two decades and people living with HIV are twice as likely to develop cardiovascular disease. To determine whether statins would reduce major adverse cardiovascular events in people living with HIV, the Randomized Trial to Prevent Vascular Events (REPRIEVE) enrolled a representative global sample of people living with HIV for whom statin treatment is not typically recommended under current guidelines to determine whether statins would reduce major adverse cardiovascular events. REPRIEVE was stopped early, after a median of 5.1 years of follow up, after demonstrating a clear effect of pitavastatin (versus placebo) to prevent major adverse cardiovascular events. For the first time, the primary findings from REPRIEVE will be shared and implications of the results for people living with HIV will be discussed to better understand their clinical relevance and applicability across global burden of disease regions and among women. The potential impact of statins on co-morbidities experienced by people living with HIV will also be discussed.

14:45 1 min	Introduction Laura WATERS CNWL, Mortimer Market Centre, United Kingdom

14:46 14 min	Key REPRIEVE results and the utility of statins among people living with HIV: What have we learned? Steven GRINSPOON Metabolism Unit, United States

15:00 10 min	Cardiovascular disease among people living with HIV in high- and low-income countries: Can one strategy fit all? Gerald BLOOMFIELD Duke University, United States

15:10 10 min	Unique aspects of cardiovascular disease among women with HIV: Lessons from REPRIEVE Markella ZANNI Massachusetts General Hospital, United States

15:20 25 min	Panel discussion: Global implications of REPRIEVE for the management of cardiovascular and other co-morbidities in HIV Beatriz GRINSZTEJN Fiocruz/INI, Brazil Laura WATERS CNWL, Mortimer Market Centre, United Kingdom Steven GRINSPOON Metabolism Unit, United States Gerald BLOOMFIELD Duke University, United States Markella ZANNI Massachusetts General Hospital, United States Rosie MNGQIBISA Enhancing Care Foundation, South Africa Anton POZNIAK Chelsea & Westminster, United Kingdom

AUTHOR

Ken Koh

SUMMARY

HIV-associated cardiovascular disease is a major co-morbid condition for people living with HIV. The Randomized Trial to Prevent Vascular Events (REPRIEVE) was terminated early for efficacy, after 5.1 median years of follow up, as it demonstrated clear beneficial effects of pitavastatin (versus placebo) to prevent major adverse cardiovascular events (MACE).

HIGHLIGHTS

Steven Grinspoon presented the REPRIEVE trial hypothesis that pitavastatin’s direct LDL reduction and pleiotropic effects would reduce MACE. Over 7000 participants were recruited from a diverse range of genders (31% natal female), race and socio-economic groups. A reduction of 35% vs placebo for time to first primary MACE, and a 21% reduction vs placebo for time to first MACE or death were the top line findings. Subgroup findings showed the effect was consistent, that no treatment modification was required in general, racial and GBD differences were nonconsequential and no treatment modification was required for HIV clinical variables. Pitavastatin as an agent unexpectedly exceeded anticipated efficacy. Gerald Bloomfield observed that traditional risk and lifestyle factors continue to be significant contributors to cardiovascular risk and need to be managed on an individual basis, in addition to the application of statin therapy. Markella V. Zanni discussed sex-based traditional metabolic and immune risk factors and accelerated reproductive aging in women with HIV, all contribute to cardiovascular risk. Women (vs. men) demonstrated higher levels of immune activation/inflammatory markers but a lower prevalence of coronary artery plaque. Future investigations into sex-based differences in immune activation and statin-induced immunomodulation will ascertain effects on cardiovascular risk.

CRITICAL ASSESSMENT

Changes to statin therapy guidelines (2019 ACC/AHA) are postulated as REPRIEVE demonstrates pitavastatin is effective and prevents MACE among people living with HIV, on ART, between the ages of 45-70 with low to moderate cardiovascular risk and normal range LDL. Individual patient centred care addressing traditional lifestyle and risk factors are still important in the management of cardiovascular risk. Treatment effects of statin therapy is consistent between genders but further studies into sex-based immune system effects will add to cardiovascular risk management. Availability of pitavastatin and national guidelines for statin use will impact on implementation of these data.