Overview

• New guidelines advocate moderate-intensity statin therapy as primary prevention for adults with HIV aged 40 to 75 whose ten-year ASCVD risk is low to intermediate.
• The REPRIEVE trial found pitavastatin reduced major adverse cardiovascular events by 36% compared to placebo in this population.
• The panel strongly recommends statins for people whose ten-year ASCVD risk score is 5% or higher and urges individualized risk assessments for those below that threshold.
• Decisions about statin initiation for people with HIV under 40 should be personalized using traditional risk factors, family history, and HIV-specific considerations.
• Preferred moderate-intensity options include pitavastatin 4 mg daily, atorvastatin 20 mg daily, and rosuvastatin 10 mg daily to minimize interactions with antiretroviral regimens.