{"id":10748,"date":"2023-07-26T16:14:08","date_gmt":"2023-07-26T20:14:08","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10748"},"modified":"2023-07-26T17:13:37","modified_gmt":"2023-07-26T21:13:37","slug":"reprieve-trial-highlights-shift-in-hiv-care-from-id-to-general-medicine","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/reprieve-trial-highlights-shift-in-hiv-care-from-id-to-general-medicine\/2023\/07\/26\/","title":{"rendered":"REPRIEVE Trial Highlights Shift in HIV Care from ID to General Medicine"},"content":{"rendered":"
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Australian White Ibis. Not an exotic bird in Brisbane!<\/p><\/div>\n

The biggest news this week at the 12th IAS Conference on HIV Science here in Brisbane, Australia, was the results of REPRIEVE<\/a>, a large randomized clinical trial conducted in people with HIV.<\/p>\n

It’s not a study of novel antiretroviral regimens, or of treatment or prevention of opportunistic infections, or of an HIV eradication strategy using latency-reversing agents or immunotherapy.<\/p>\n

Nope — it’s a study of cardiovascular prevention with an exotic class of drugs called statins<\/em>.<\/p>\n

(Sarcasm alert.)<\/em><\/p>\n

That’s right, statins. As noted here several years ago<\/a>, REPRIEVE recruited stable people with HIV age 40 or older, on ART, and at low to moderate risk of cardiovascular disease — people for whom a statin would generally not be prescribed. Since HIV confers up to a 2-fold increased risk of CVD compared to people without HIV, the hypothesis was that a statin would reduce the risk of a major adverse cardiovascular event compared to placebo.<\/p>\n

The drug chosen was pitavastatin, since it doesn’t interact with any ART regimen. 7769 people enrolled at study sites throughout the world, with diverse demographics and broad geographic representation. It was a “simple” (nothing this size is really simple) study design, with randomization to pitavastatin or matching placebo.<\/p>\n

After a median follow-up of approximately 5 years, the data and safety monitoring board overseeing the study stopped the study early because of a highly significant benefit of pitavastatin — the risk reduction for pitavastatin vs. placebo was 35%.<\/p>\n

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REPRIEVE: Significant decrease in major adverse cardiovascular events with pitavastin.<\/p>\n

RCT trial enrolled only low-to-moderate CV risk PWH, for whom a statin might not otherwise be prescribed.<\/p>\n

Important clinical trial with direct relevance to pt care. https:\/\/t.co\/dVtQgtAGhz<\/a> pic.twitter.com\/eI5ZeOvzcB<\/a><\/p>\n

— Paul Sax (@PaulSaxMD) July 24, 2023<\/a><\/p><\/blockquote>\n