On February 27, 2024, the United States Department of Health and Human Services, in collaboration with representatives from the American College of Cardiology, American Heart Association, and the HIV Medicine Association released updated recommendations for the use of statin therapy​ as primary prevention of atherosclerotic cardiovascular disease (ASCVD) in people with HIV.

With antiretroviral therapy (ART) and viral suppression, people with HIV can achieve a life expectancy close to that of people without HIV, but there remains a mortality gap primarily due to higher rates of cardiovascular disease and cancer. Generally, people at low-to-intermediate risk of ASCVD have not been recommended to take statin therapy.  A recent clinical trial called REPRIEVE enrolled people with HIV aged 40 to 75 years with low-to-intermediate risk of ASCVD and randomized them to receive either a statin called pitavastatin or a placebo. In the trial, people who received pitavastatin 4 mg daily had a 35 percent reduction in major adverse cardiovascular events over a median follow-up duration of 5 years compared with placebo. These results led to this new joint recommendation:

For people with HIV aged 40 – 75 years who have a low-to-intermediate (5% to <20%) 10-year ASCVD risk estimate, moderate intensity statin therapy is recommended with one of the following statins:

1. Pitavastatin 4mg once daily (AI)
   
2. Atorvastatin 20mg once daily (AII)
3. Rosuvastatin 10mg once daily (AII)

Pitavastatin, atorvastatin, and rosuvastatin are currently on the ADAP formulary and clinical and local prescribers may prescribe these medications in concordance with these new recommendations. 

ADAP management requests that you share this information with your clinical leadership team and local prescribers.

If you have any questions regarding this memo, please contact the OA Formulary Specialist, James Vo (James.Vo@cdph.ca.gov ).

Thank you,