Statins Can Help Prevent Heart Disease in People with HIV— Are We Looking at the Right Risks?
People with HIV are living longer, thanks to modern medicine, but they still face a higher risk of heart disease. Doctors have long recommended statins—(medication that lowers cholesterol)—to help prevent heart attacks and strokes. Now, new findings from the REPRIEVE trial, presented at the CROI 2025 Conference, show that statins do help.
However, the study also raises a big question: Are doctors using the right tests to find out who needs these drugs the most?
Dr. Steven Grinspoon and his team at Massachusetts General Hospital found that a certain type of hidden artery plaque—called non-calcified plaque (NCP)—might be a better warning sign for heart disease in people with HIV than the standard test that looks for hardened (calcified) plaque.
This finding could change how doctors decide who should take statins and help more people get the treatment they need before a serious heart problem occurs.
What Did the Study Find?
Researchers followed 804 people with HIV for nearly six years, tracking their plaque levels, inflammation, and early signs of heart damage. Here’s what they found:
- 40% of participants already had soft (non-calcified) plaque in their arteries.
- People with this plaque were more likely to have serious heart problems later.
- Inflammation markers, such as hs-CRP and IL-6, were linked to higher heart risk.
- Pitavastatin (a type of statin) worked best in people who already had this soft plaque or early signs of heart injury.
This means that people with HIV who already have early signs of heart disease may benefit the most from taking statins.
Are Doctors Using the Right Test?
In the general population, doctors often use a coronary artery calcium (CAC) scan to decide who needs statins. This test looks for hardened plaque—the kind that builds up over time and increases the risk of heart attacks.
But at the CROI 2025 conference, Dr. Laura Waters from NHS London asked a key question:
“If I understand correctly, coronary calcium should not be used to decide if people with HIV need statins. In the US, calcium scans are used to help determine who should take them. For people with HIV, you’re saying that soft, non-calcified plaque may be more important. Is that right?”
Dr. Grinspoon confirmed that while CAC scans are useful in the general population, they may not work as well for people with HIV:
“There’s a higher amount of non-calcified plaque in people with HIV. Coronary calcium does predict heart disease, but not as strongly as non-calcified plaque does in this group.”
In other words, the usual test might miss many people with HIV who are actually at high risk.
He also emphasized that anyone with a heart disease risk over 5% should consider statins—regardless of what a calcium scan shows (Grinspoon et al., CROI 2025).
What This Means for People with HIV?
- Statins help – The REPRIEVE trial confirms that statins lower heart disease risk in people with HIV (Grinspoon et al., 2023).
- Some people benefit more – Those who already have soft plaque or inflammation may get the biggest benefit from statins.
- Doctors may need to change how they assess risk – Instead of just using calcium scans, they may need to look at soft plaque and inflammation levels in people with HIV.
The Bottom Line
If you have HIV, keeping your heart healthy is just as important as managing your HIV virus.
This study shows that statins can protect against heart attacks and strokes, even in people who don’t yet have symptoms.
If your doctor talks about checking your heart health, ask about soft plaque and inflammation markers in addition to a calcium scan. The REPRIEVE trial has made one thing clear: statins can make a real difference in protecting the hearts of people with HIV—if we make sure they’re given to the right people.
