Dubai, United Arab Emirates (CNN) — Scientists have long known that people with HIV face a higher risk of heart disease. However, pitavastatin may offer a solution.
In a phase 3 clinical trial, participants with HIV who received pitavastatin, a cholesterol-lowering drug, were 35 percent less likely to have serious heart complications, including heart attacks, heart failure or strokes.
The findings were published Sunday in the New England Journal of Medicine and presented at a meeting of the International AIDS Society in Brisbane, Australia.
The report offers a promising new way for people living with HIV to better manage their heart health.
HIV attacks and weakens the body’s immune system, leaving patients vulnerable to other, often fatal, diseases.
Although there is no cure for HIV, antiretroviral therapy can help people manage the disease and lead an almost normal life.
However, people with HIV face twice the risk of heart disease and cardiovascular complications compared to the general population, according to Patrice Desven-Nickens, MD, a physician in the Heart, Lung, and Blood Institute’s division of cardiovascular sciences, who was involved in the trial.
Heart complications occur much earlier – and are more deadly – in people with HIV.
While scientists aren’t completely sure of the cause, experts think it may be a result of the severe and persistent inflammation and chronic immune activation caused by HIV.
“This has become a major issue for the HIV community,” explained Stephen Grinspoon, a professor of medicine at Harvard Medical School and lead author of the study.
“They still have heart attacks and strokes, even though they are receiving effective antiretroviral treatments. They don’t have HIV-specific comorbidities; they do have heart disease,” Grinspoon said.
The study gathered more than 7,700 participants worldwide, ages 40 to 75, all of whom had HIV infection, were currently receiving antiretroviral treatment, and were classified as having a low-to-moderate risk of heart disease.
Each participant was randomly assigned to receive either a daily dose of pitavastatin or a placebo.
Pitavastatin belongs to a class of medications called statins, which reduce the amount of cholesterol made by the liver and help the liver break down cholesterol in the blood.
As a result, the medicine lowers your LDL cholesterol – or “bad cholesterol”, which can build up inside your blood vessels and cause heart problems.
Pitavastatin was chosen specifically for the HIV trial, as it does not interact with antiretroviral drugs, which makes it “astonishingly ideal”, she explains to Desvin Nickens.
Grinspoon noted that the drug is also widely available and “relatively inexpensive”.
During the trial, the researchers found that HIV-positive patients who received pitavastatin were 35% less likely to experience an “adverse” heart event, such as a heart attack, compared to a control group in the study.
They also saw a 21% reduction in the incidence of cardiovascular disease and death in the patients, Desphine Nickens said.
And if pitavastatin only lowered LDL cholesterol levels, it would have only been a 17% reduction in cardiovascular disease risk, according to Grinspoon.
As a result, the report notes, the treatment does more than just lower low-density lipoprotein levels, it also reduces immune activation and inflammation that put people with HIV at risk of heart disease in the first place.
Grinspoon believes that many physicians will begin to incorporate the results of the trial into their clinical practices.
Grinspoon hopes the findings will prompt regulators to consider incorporating pitavastatin into standard care for people living with HIV.
The researchers’ optimism stems from the diverse scope of the trial. The study was conducted across 12 countries, including several in sub-Saharan Africa, Asia, South America and the Caribbean, countries with a high HIV burden.
The study included 30% women, and 65% of them were darker skinned – a striking comparison for research that has historically neglected these groups.
For people on antiretroviral therapy, the researchers also hope pitavastatin won’t add too much of a burden.
Because it is an affordable and accessible daily medication, Desphine Nickens noted, it may be an easier addition to the medication routine of someone living with HIV, who may already have “complicated drug regimens.”
2023-07-25 06:46:21
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