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.

中文翻译：

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他汀类药物在 HIV 中的应用：欧洲 AIDS 临床学会心血管疾病一级预防指南。


动脉粥样硬化性心血管疾病 （ASCVD） 是 HIV 感染者的重要合并症。过度代表典型的危险因素（如吸烟）和其他因素（如 HIV 感染及其治疗）是 HIV 感染者独有的，是导致患 ASCVD 风险增加的原因。估计风险的工具，包括系统性冠状动脉风险评估 2 （SCORE2），通常低估了 HIV 感染者的风险。预防 HIV 血管事件的随机试验 （REPRIEVE） 研究表明，在具有低至中度 ASCVD 风险的 HIV 感染者中，匹伐他汀可显著降低主要不良心血管事件的发生率。根据这些结果，欧洲艾滋病临床学会建议对 SCORE2 值在 5% 到低于 10% 之间的 HIV 感染者使用中等强度的他汀类药物，如果年龄超过 50 岁且没有其他列出的危险因素，则为 ≥2·5%。对于 SCORE2 <5% 的 40 岁及以上的 HIV 感染者，可以考虑使用中等强度的他汀类药物。尽管预计 REPRIEVE 研究结果将对临床护理产生重大影响，但由于缺乏足够的指导或获得他汀类药物的机会、对耐受性和潜在药物相互作用的担忧以及难以保持依从性，可能会阻碍实施。欧洲艾滋病临床学会的这些关键建议旨在为这一职权范围提供支持。