Alagaratnam Jasmini, van Bremen Kathrin, Behrens Georg M N, Boccara Franck, Cinque Paola, Gisslén Magnus, Guaraldi Giovanni, Konopnicki Deborah, Kowalska Justyna D, Mallon Patrick W G, Marzolini Catia, Mendão Luis, Miró José M, Negredo Eugenia, Reiss Peter, Ryom Lene, van der Valk Marc, Winston Alan, Nielsen Susanne D, Martínez Esteban
Department of HIV Medicine & Sexual Health, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK; Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK.
MVZ Internal Medicine Cologne, Cologne, Germany.
Lancet HIV. 2025 May;12(5):e382-e392. doi: 10.1016/S2352-3018(25)00047-5.
Atherosclerotic cardiovascular disease (ASCVD) is an important comorbidity in people ageing with HIV. Over-representation of classic risk factors such as smoking, and other factors such as HIV infection and its therapy, which are exclusive to people with HIV, are responsible for the increased risk of developing ASCVD. The tools to estimate risk, including Systematic Coronary Risk Evaluation 2 (SCORE2), generally underestimate risk in people with HIV. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study showed that pitavastatin among people with HIV with low-to-moderate ASCVD risk significantly reduced the incidence of major adverse cardiovascular events. Following these results, the European AIDS Clinical Society recommends the use of moderate-intensity statins for people with HIV with a SCORE2 value between 5% and less than 10%, or ≥2·5% if older than 50 years with no additional listed risk factors. Moderate-intensity statins can be considered in people with HIV aged 40 years and over with a SCORE2 <5%. Although the REPRIEVE study findings are expected to have a major effect on clinical care, implementation could be hampered by the absence of adequate guidance or access to statins, concerns about tolerability and potential drug interactions, and difficulties in maintaining adherence. These key recommendations from the European AIDS Clinical Society aim to provide support in this remit.
动脉粥样硬化性心血管疾病（ASCVD）是HIV感染者衰老过程中的一种重要合并症。吸烟等经典风险因素以及HIV感染及其治疗等HIV感染者特有的其他因素的过度存在，导致了患ASCVD风险的增加。包括系统冠状动脉风险评估2（SCORE2）在内的风险评估工具，通常会低估HIV感染者的风险。预防HIV血管事件随机试验（REPRIEVE）研究表明，对于ASCVD风险低至中度的HIV感染者，匹伐他汀可显著降低主要不良心血管事件的发生率。基于这些结果，欧洲艾滋病临床学会建议，对于SCORE2值在5%至小于10%之间的HIV感染者，或50岁以上且无其他所列风险因素时SCORE2≥2.5%的HIV感染者，使用中等强度他汀类药物。对于40岁及以上、SCORE2<5%的HIV感染者，可考虑使用中等强度他汀类药物。尽管REPRIEVE研究结果预计会对临床护理产生重大影响，但由于缺乏充分的指导或他汀类药物的获取途径、对耐受性和潜在药物相互作用的担忧以及维持依从性的困难，实施可能会受到阻碍。欧洲艾滋病临床学会的这些关键建议旨在为此提供支持。
