No decline in physical function when people with HIV take statin therapy for primary prevention

The use of pitavastatin therapy to prevent cardiac disease in people living with HIV is not associated with worsening in physical function, researchers have found—despite the fact that myalgias are a known side effect of statins and the prevalence of chronic pain is high in this population.

About This Study

“Pitavastatin is Well-Tolerated with no Detrimental Effects on Physical Function” was published online on August 19, 2024, in Clinical Infectious Diseases. The lead author is Kristine M. Erlandson, M.D., of the University of Colorado Denver- Anschutz Medical Campus, Aurora. The parent REPRIEVE trial was funded in part by Kowa Pharmaceuticals, the manufacturer of pitavastatin, and by Gilead Sciences and ViiV Healthcare, both manufacturers of antiretroviral drugs.

Key Research Findings

This sub-study of the randomized REPRIEVE trial of pitavastatin to prevent heart disease in people living with HIV assessed physical function in 602 U.S. participants, 316 of whom were taking the study drug. Myalgias are a side effect of statins and chronic pain is common among people living with HIV, prompting researchers to assess whether the study drug affects muscle pain and weakness, and as a consequence physical function, in this population.

Study participants were mostly Black and Brown men (18% of participants assigned female at birth, 2% of participants transgender, 40% of participants Black, and 18% of participants Latinx). Median age at baseline was 51 years and follow-up was a median 4.7 years. Roughly a quarter of participants who completed the follow-up period stopped treatment before the study’s end, often due to participants’ decisions or because statin therapy was started based on clinical implications and the standard of care. Treatment discontinuation rates were similar between the two arms.

Annual tests assessed the speed of getting up from a chair and walking, grip strength, and balance. Chair rise speed did not change over time in either group. While the performance on the other tests declined slightly over time, it did not differ by statin use.

Participants in both groups reported low-grade muscle aches and weakness, with <5% of participants in either group (4.7% of statin users, 4.5% of placebo users) experiencing grade ≥3 pain.

Discussion Highlights and Implications for Practice

Study limitations reported included the small number of women, participants’ young age, the U.S.-only design, and the relatively good overall health of participants in the parent study.

The researchers pointed out that the lack of change in the chair rise rate was surprising and could be due to participants practicing this exercise or their younger age.

Results show that the study drug is safe over long periods to prevent cardiovascular events in people living with HIV, study authors concluded.

By Barbara Jungwirth