Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin HIV AIDS. 2022 Sep 1;17(5):293-300. doi: 10.1097/COH.0000000000000752. Epub 2022 Jul 16.
While people with HIV (PWH) are living longer due to advances in antiretroviral therapy, recent data have demonstrated an increased risk of cardiovascular disease (CVD) among this population. This increased risk is thought to be due to both traditional (for example, smoking, diabetes) and HIV-specific (for example, inflammation, persistent immune activation) risk factors. This review focuses on the potential for statin therapy to mitigate this increased risk.
Several randomized clinical trials have demonstrated that statins, a class of lipid-lowering medications, are effective as a primary CVD prevention strategy among people without HIV. Among PWH, statins have been shown to lower cholesterol, exert immunomodulatory effects, stabilize coronary atherosclerotic plaque, and even induce plaque regression.
Prevention of CVD among the aging population of people with controlled, but chronic, HIV is vital. Data exploring primary prevention in this context are thus far limited. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is ongoing; this trial will inform the field by investigating the effects of pitavastatin calcium as a primary prevention strategy for major adverse cardiovascular events among PWH on antiretroviral therapy (ART) at low-to-moderate traditional CVD risk.
随着抗逆转录病毒疗法的进步，艾滋病毒感染者（PWH）的寿命得以延长，但最近的数据显示，该人群的心血管疾病（CVD）风险增加。这种风险增加被认为是由于传统（例如，吸烟、糖尿病）和 HIV 特异性（例如，炎症、持续的免疫激活）风险因素造成的。本综述重点介绍他汀类药物治疗减轻这种风险的潜力。
几项随机临床试验表明，他汀类药物是一类降脂药物，对于没有 HIV 的人来说，作为主要的 CVD 预防策略是有效的。在 PWH 中，他汀类药物已被证明可降低胆固醇、发挥免疫调节作用、稳定冠状动脉粥样硬化斑块，甚至诱导斑块消退。
对于控制但慢性 HIV 的老龄化人群，预防 CVD 至关重要。到目前为止，探索这方面一级预防的数据有限。预防 HIV 相关血管事件的随机试验（REPRIEVE）正在进行中；该试验将通过研究钙泊三醇作为低至中度传统 CVD 风险的抗逆转录病毒治疗（ART）的 PWH 主要不良心血管事件的一级预防策略的效果来为该领域提供信息。
