In the early years of the HIV epidemic, receiving the diagnosis of this infection almost always meant a long process of illness ahead. At that time, scientific efforts were concentrated on developing some intervention that would stop the overwhelming ability of AIDS to kill.
From the end of the 1990s, with the development of antiretroviral treatment, it became possible to interrupt the natural evolution of the disease and make an infected person spend his whole life just living healthy with HIV, without ever developing AIDS .
As access to antiretroviral therapy has expanded around the world, we have first witnessed the precipitous drop in deaths from AIDS. Later, however, we learned that among people living with HIV on adequate treatment, some cardiovascular events, such as myocardial infarctions and cerebrovascular accidents (CVAs), occurred somewhat more frequently than in the general population.
In addition to the classic risk factors for these cardiovascular events, such as smoking, physical inactivity, diabetes, hypertension and high cholesterol, over time it became clear to epidemiologists that HIV infection also seemed to be associated with a higher occurrence of these outcomes.
The most accepted explanation in the scientific community for this phenomenon considers that HIV infection can cause a persistent increase in inflammation in the body of an infected person. This inflammation even reduces after starting antiretroviral treatment, but it does not always return to its baseline. It is this chronic inflammation that can lead to a number of unfavorable health outcomes, such as cardiovascular events.
This theory made researchers understand that antiretroviral treatment was undoubtedly essential to stop the progression of HIV infection to AIDS, but that some intervention was also necessary to reduce the cardiovascular risk of people living with HIV.
With that in mind, the Reprieve study was designed to test pitavastatin for this role, a drug from the statin class that, in addition to its cholesterol-lowering effect, also has an anti-inflammatory effect.
Launched in 2015, Reprieve globally recruited 7,769 male and female participants aged between 40 and 75 years, all living with HIV on adequate antiretroviral therapy and without indication of statin use due to increased cholesterol, to receive a daily pitavastatin pill or of placebo.
After being included, the participants were followed up on periodic visits with records of cardiovascular events and side effects.
Last week, after an interim analysis of the study data, an independent scientific committee recommended its discontinuation, as 35% fewer cardiovascular events occurred in the arm drawn to receive the statin than in the arm drawn to receive the placebo.
The result was enthusiastically received by the international scientific community, as, for the first time, a drug intervention was able to significantly reduce the cardiovascular risk of people living with HIV undergoing antiretroviral treatment.
Full data and study details are due to be published in the coming weeks, and from there we can begin to outline how we can incorporate the learnings from the Reprieve study into clinical practice and the individual care of patients living with HIV.
From now on, I think we should celebrate more this advance in scientific research on HIV/AIDS, but we can never forget that the adoption of a healthy lifestyle with proper nutrition, smoking cessation and regular physical activity can also bring health benefits with the reduction of cardiovascular risks.
By improving HIV/AIDS care, we will be able to offer more health and quality of life to people living with this virus every day.
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