Experts recommend statins for all people with HIV aged 40+

[Jim Allen]

No comment about his at the moment. I am still reading.

Aidsmap.com article in full: UK experts recommend statins for all people with HIV aged 40 and over

https://www.aidsmap.com/news/nov-2023/uk-experts-recommend-statins-all-people-hiv-aged-40-and-over

In Short:

The British HIV Association (BHIVA) has recommended that everyone living with HIV aged 40 and over should take a statin to reduce their risk of heart disease, even if they do not have raised cholesterol or a high risk of heart disease.

The new guidance, issued this week, is the first in the world to respond to the results of the REPRIVE study, presented at the International AIDS Society Conference on HIV Science in July. The study showed that taking pitavastatin daily reduced the risk of a major cardiovascular event such as heart attack, stroke or a clinical intervention to treat a serious heart disorder by 35% in people with HIV. Crucially, the study only recruited people with a low-to-moderate risk of serious heart disease within ten years.

[Loa111]

This is very interesting. I read the whole article.

Interested to see ifs the Statin recommendation make it over to Ireland in due course?

I know my ID consultant has an interest in heart disease within HIV patients.

If it can mean reduced heart disease risk then it must be a good thing?

[Jim Allen]

This is very interesting. I read the whole article.

Interested to see ifs the Statin recommendation make it over to Ireland in due course?

Yeah, it will; they already (briefly) mentioned a statin on my last visit. I'll presume now that it  will be an even bigger topic next time.

If it can mean reduced heart disease risk then it must be a good thing?

Yeah, I would hate to have early heart disease, but I need to do a bit more reading on the evidence and the particular statins mentioned before considering them.

[kentfrat1783]

Well since I'm in the US it may be a few years before this is at topic with my PC or ID appointment, but may be something I bring up.

I have got into a good fitness routine, improved my diet, and reduced my alcohol intake but as HIV does increase caridovasular issues so having a little help I don't see as a bad thing. 

The part that I want to see more emphasis place on is this

But as well as recommending statin use, HIV clinics and GPs should also provide advice and signposting on smoking cessation, exercise, diet, weight management and alcohol use, to address other cardiovascular risk factors.

With all of the medical benefits of "Exercise" why is a gym membership not part of medical care that is covered under insurance?  Yes, I now many don't go that have a memebership but have it setup in a way that you have to go X time a month to get it covered.  Maybe that is what helps more, or at least helps some, at preventing a heart attach and is better then just popping another pill.

[Jim Allen]

https://www.poz.com/article/british-experts-recommend-statins-allpositive-people-40-older

[Tonny2]

            ojo.            Study too late for me, I already have heart disease, got a heart attack in 2010 due to a medication according to the doctor. Since then I’ve been taking Lipitor. I was 48 years so and then. I think that is a good recommendation….hugs

[numbersguy82]

Interesting… my docs have been trying to get me on a statin for a while now, but I resisted. Admittedly I never did much research and just believed the general thinking that statins can be more harmful than helpful.

I can see myself going down the research rabbit hole now before my next appointment with my ID Doc in January.

@Tonny you are such an inspiration. You’ve been through so much, yet here you still are living your best life and making these forums a brighter space ❤️

[leatherman]

believed the general thinking that statins can be more harmful than helpful.

I think what we're seeing is, once again, long term survivors at the forefront of another HIV-related issue.

While HIV treatment is pretty routine and highly effective these days, it wasn't always. For every newbie starting treatment with bi-monthly Cabenuva, there's a cadre of LTSes who took AZT, Atripla, Norvir, Truvada. The usage of those meds, and the results of that treatment, is what has continued to lead the research for ARV improvements to the regimens in use today.

Negative issues with cholesterol have been going on since the beginnings of ARVs. I would venture to suggest though that staying alive against HIV was a much more profound outcome than out-of-range cholesterol issues. Dying of a heart attack 10 years in the future than die today of AIDS was the better outcome of treatment years ago. The improvement of meds has lessened, but not removed, this kind of issue. Cholesterol issues are still an issue with PLHIV because of HIV itself and because of some medications.

So with so many PLHIV aging, LTSes along with newer-diagnosed people over the age of 50, we're into a period now of dealing with long term ARV usage along with general aging issues. It's been 20 years later (which is better than that 10 yrs we used to hope for) and now we've got to deal with the heart attack issues.

My previous doctor (we have his protege now) talked to me about this issue 5 or so years ago as my HDL began to drift down and LDL started climbing. Along with adding a better diet to the exercise I was already doing, we decided to add a statin. Since I first made the fateful decision to take AZT a zillion years ago, I've never been adverse to trying a drug for an improvement or even taking a drug as a precaution.

[BubbaPat]

So.. I read the article and am interested how they want to handle those of us on Triumeq which contains abacavir.

"BHIVA recommends avoiding abacavir and lopinavir/ritonavir in people with high cardiovascular risk."

My family doesn't have a history of heart disease, more of a history of not taking care of themselves properly.  My father outlived a larger of number because he actually listened to his doctor when he had a heart attack at 58. ( I was .  I was in my 20s. 

I'll be interested to see what my doctor says on my next visit.  Currently we're working on getting my ADHD meds balanced out.

Tonny....my little ray of sunshine...you are amazing.  I wish I had just a once of your optimism to see everything though.  Every time I get on here and read your words, 9 times out of 10 I wind up tearing up because you're just so freaking awesome!!  You seem to handle everything thrown your way.  Bubba hugs from Texas.

Patrick

[Jim Allen]

So.. I read the article and am interested how they want to handle those of us on Triumeq which contains abacavir.

Try and push us onto Dovato I presume as that's DTG + 3TC. 

[Mindless]

Try and push us onto Dovato I presume as that's DTG + 3TC.

Hello Jim,

I'm not participating much in the forums lately, but I always read your comments with interest. You're a source of inspiration and knowledge. Thanks for your hard work 🙏🏻

 I have a little question about your last comment: what do you mean by "pushing us", you think there are ulterior motives? Just out of curiosity. I'm on Dovato BTW, and taking Rosuvastatin.

Hi Tonny, nice to read your comments, you're a source if inspiration too 💪💪

[Jim Allen]

Hello Jim,

I'm not participating much in the forums lately, but I always read your comments with interest. You're a source of inspiration and knowledge. Thanks for your hard work 🙏🏻

 I have a little question about your last comment: what do you mean by "pushing us", you think there are ulterior motives? Just out of curiosity. I'm on Dovato BTW, and taking Rosuvastatin.

Ulterior motives, absolutely not, and I am glad you asked. I did not realize it could be interrupted that way; thanks for highlighting this, and I will clarify why I think this and feel this way.

It was not intended as a statement of fact, but as a patient it's sometimes how I feel... Also, I see this as a logical step for doctors to recommend. It's the same reasoning that my doctors seem to have expressed (too much for my liking) over the past few clinic visits: Dovato is new, etc., etc., and it feels like I am being "pushed" into something at times, although because I ask questions, the conversation ends fast, as they can't address my concerns or convince me, show or prove to me it's better.

But generally, if a person is happy and stable on Triumeq (DTG+3TC+ABC), and the doctor recommends dropping abacavir. It would seem to me as a layman, the odds are they are going to recommend the easiest possible switch with the least amount of unknowns, and I presume, Dovato (DTG+3TC) that relatively new will for many be a primary recommendation in the above scenario as it has the same drugs, just minus the ABC.

Again, I'm just a layman, and there is zero personal gain for Doctors in my part of the world to recommend one drug over another without good medical cause. 


Overall, I feel we, as PLHIV, are ultimately in charge and need to be more in charge of our healthcare than we generally seem to be within certain limits for the best personal outcomes.

That said, I have decided not to switch to Dovato (Dual therapy). Still, I am considering dropping ABC as I am getting older. So, I will be looking for a different triple combination (HAART) ... Again, this is just a personal choice based on my knowledge and concerns.

[Mindless]

That said, I have decided not to switch to Dovato (Dual therapy). Still, I am considering dropping ABC as I am getting older. So, I will be looking for a different triple combination (HAART) ... Again, this is just a personal choice based on my knowledge and concerns.

Thank you for clarifying Jim. But as someone who has switched from Complera to Dovato, now I have to ask: why are you not considering it as a viable option? Maybe not the right thread to discuss this, but I'm starting to worry.

Thanks

[Jim Allen]

Thank you for clarifying Jim. But as someone who has switched from Complera to Dovato, now I have to ask: why are you not considering it as a viable option?

Nothing new; I've never considered it an option for me, and I've mentioned that before. However, it is a great option for many people, particularly those with issues with their current treatment or need to simplify it. I hope future development continues to give us more treatment options.

As for my treatment well, Dovato isn't a superior option in my opinion, and I am very risk-averse about treatment failure when it comes to picking my own HIV treatment; I always worried about the flexibility with Dovato and 3TC failing leading to treatment failure or resistance developing.

Discussed a bit more in these two threads.
https://forums.poz.com/index.php?topic=77560.0
https://forums.poz.com/index.php?topic=77539.0

I'm starting to worry.

Because I would not take Dovato? Don't stress about it.

Plenty of people talk here and elsewhere about HIV meds and their concerns/misgivings, personal treatment choices or negative & positive experiences over the decades. It's nothing new or to be worried about. End of the day, if Dovato is working for you, happy days.

[BubbaPat]

But generally, if a person is happy and stable on Triumeq (DTG+3TC+ABC), and the doctor recommends dropping abacavir. It would seem to me as a layman, the odds are they are going to recommend the easiest possible switch with the least amount of unknowns, and I presume, Dovato (DTG+3TC) that relatively new will for many be a primary recommendation in the above scenario as it has the same drugs, just minus the ABC.

Howdy Jim!
I'm on Triumeq and wonder why would drop the abacavir?  I'm not as well read as I should be.  My brain starts to wander when I start reading up on medical subjects.  I blame ADHD because my thoughts start wondering then I can't remember what or why I was looking up.

Bubba hugs!
Patrick

[Jim Allen]

Howdy Jim!
I'm on Triumeq and wonder why would drop the abacavir?  I'm not as well read as I should be.  My brain starts to wander when I start reading up on medical subjects.  I blame ADHD because my thoughts start wondering then I can't remember what or why I was looking up.

Bubba hugs!
Patrick

Why? Because there seems to be some correlation between ABC and cardiovascular problems. *
It's not news; this has been known for many years, mostly thought to be more related to people with preexisting issues, or that was always my takeaway.

* some example papers (plenty of others):

2022 Approximately 1 in 200 people taking abacavir suffer cardiovascular events each year
https://www.aidsmap.com/news/oct-2021/large-international-study-finds-40-higher-risk-serious-cardiovascular-problems-people

2018: The Causes of HIV-Associated Cardiomyopathy: A Tale of Two Worlds
https://pubmed.ncbi.nlm.nih.gov/26885518/

2014 Cardiovascular risks associated with abacavir
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3910369/

[Jim Allen]

The topic of "statins for all people with HIV aged 40+" was also a discussion point at the recent conference attended.

https://forums.poz.com/index.php?topic=77637.0

[CircularNatural]

Hey Jim, upon reading you, you make me wonder since I´ve started my treatment on 2021 with Dovato and have been undetectable every since.
I´ve read that it´s the dolutegravir branch o the treatment that conveys my combo a low treatment resistance risk.
Do you think otherwise?
Overall I´m happy with Dovato and wouldn't want to change unless something new that shows better long-term safety, which in turn is a bit contradictory since for that to happen that new treatment would need time and experience.
Cheers

[Jim Allen]

Yeah, so DTG (Dolutegravir) itself generally speaking has a high barrier to resistance.* meaning even with treatment failure happens resistance to the DTG part of the treatment is low. Not to mention that even with some resistance double dosing DTG could still work.

*( I'm on my phone but will add a reference when I get home)

Overall I´m happy with Dovato

👍 Cool, if it's working for you, stick with it. 

wouldn't want to change unless something new that shows better long-term safety, which in turn is a bit contradictory since for that to happen that new treatment would need time and experience.

I'm feel the same, hence now I am going to switch as I want to drop ABC it will be to another HAART combo.

[Jim Allen]

By Liz Highleyman - POZ.com article in full: https://www.poz.com/article/us-hiv-guidelines-recommend-statins-prevent-cardiovascular-disease

In brief:

The Department of Health and Human Services (DHHS) has updated its antiretroviral treatment guidelines to recommend statins for people living with HIV who are ages 40 to 75 and have a low to intermediate risk for cardiovascular disease (CVD).

As people with HIV live longer thanks to effective antiretroviral treatment, cardiovascular disease has become a leading cause of illness and death. Studies show that HIV-positive people have about a twofold higher risk for CVD than their HIV-negative peers. What’s more, people with HIV experience cardiovascular complications at younger ages. In part, this may be due to chronic inflammation that persists even in people on effective HIV treatment.

The new DHHS guidelines were developed in collaboration with the American College of Cardiology, the American Heart Association and the HIV Medicine Association.

• For people with HIV ages 40 to 75 who have high (20% or greater) 10-year ASCVD risk scores, the guidelines recommend starting high-intensity statin therapy—the same as the recommendation for HIV-negative people.
• For HIV-positive people ages 40 to 75 with low to intermediate (5% to just under 20%) 10-year risk scores, the guidelines recommend starting at least moderate-intensity statin therapy, for example 4 milligrams once-daily pitavastatin, 20 mg once-daily atorvastatin (Lipitor) or 10 mg once-daily rosuvastatin (Crestor).
  
• For those in this age group with 10-year risk estimates below 5%, the guidelines still favor initiating at least moderate-intensity statin therapy. However, the authors acknowledge that the absolute benefit from statins is modest for this population, so decision-making should take into account HIV-related factors that can increase CVD risk.
  
• For people with HIV under age 40, there is not enough data to recommend either for or against statin therapy for primary CVD prevention. For HIV-negative people of this age, lifestyle modification is recommended, with statin therapy considered only for specific groups at higher risk.
  
• For the general population, people ages 20 to 75 with elevated LDL levels (190 or higher) are advised to start high-intensity statin therapy, and those ages 40 to 75 with diabetes are advised to start at least moderate-intensity statin therapy. These recommendations should also apply to people with HIV.
• For people over 75, the guidelines do not offer a recommendation, as there are inadequate study data for this age group