The ongoing global REPRIEVE trial, which has enrolled 7,700 people taking HIV treatment, seeks to determine the effect of a cholesterol-lowering statin on cardiovascular disease (CVD) outcomes among people with HIV. But the study findings are already shedding light on many other pressing questions about the health of people living, and aging, with the virus.
The highly diverse group of HIV-positive participants entered the multiyear study with a low to moderate risk for CVD according to standard risk calculators. They were randomized to receive either Livalo (pitavastatin) or a placebo. When entering the study, the participants had a median age of 50, had been living with the virus for a median of 13 years and had been on antiretrovirals for a decade.
While the central CVD-related results of REPRIEVE are not expected until 2023, the study authors have already made some important preliminary findings about comorbidities, or other health conditions, among the participants.
A substantial number of the study members have signs of reduced renal, or kidney, function. It’s possible that Livalo may end up slowing or preventing further declines in their kidney function.
Concerningly, many of the study members have excess fat around the heart, which is tied to a higher risk of heart trouble. The study population also has a high rate of impaired muscle strength and function, which potentially indicates widespread frailty.
Women of more advanced reproductive age in the study are more likely to have a larger waist (measured as waist circumference) and high blood levels of hemoglobin, both of which are CVD risk factors.
Among the 2% of the participants who are transgender women, high waist circumference is more common, in particular among those receiving gender-affirming hormones; such treatment has also been tied to a higher risk for CVD.
“These findings highlight the significant prevalence of major comorbidities—including cardiovascular disease, frailty, renal disease and premature ovarian aging—and the promise of REPRIEVE to provide critical information relevant to the health and well-being of people with HIV,” says the study’s primary investigator, Steven Grinspoon, MD, of Harvard Medical School.