With effective antiretroviral therapy people living with HIV infection are now largely a group with a chronic, manageable disease associated with a higher risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Myocardial infarction, heart failure, stroke, and other CVD are more common amongst people living with HIV than for people who are not infected. Recently published in the journal Circulation, a scientific statement from the American Heart Association addresses the characteristics, prevention, and management of cardiovascular disease amongst people living with HIV.

Although in some cases definitive evidence from specific large scale clinical trials is lacking, the document does attempt to provide some practical guidance. It is highlighted that statins significantly reduce CVD events in patients without HIV with increased inflammation and low levels of LDL-C. It is highlighted that other CVD risk factors, especially smoking, are common and should be addressed. Statin use in HIV is complicated by potential drug interactions. Potent cytochrome P450 (CYP) inhibitors such as ritonavir and cobicistat interact with specific statins, and the statement points out that simvastatin and lovastatin are extensively metabolized by these enzymes, potentially increasing serum concentrations >500% when coadministered. Atorvastatin and rosuvastatin are advocated as safer alternatives. Vitamin D deficiency is also associated with statin intolerance amongst people with HIV infection.

The publication also points to a comprehensive, searchable website that provides excellent resources in connection to the complexities of management of HIV infection and associated issues, published by US Department of Health and Human Services – this is an excellent resource in its own right and can be accessed here