ACTG Announces Publication of REPRIEVE Substudy in JAMA Network Open, Providing Information on Cardiovascular Disease Risk in People Living with HIV



Los Angeles, California – The AIDS Clinical Trials Group (ACTG), the world’s largest HIV research network, today announced the results of a sub-study of REPRIEVE (A5332 / A5332s, a clinical trial international study on the prevention of heart disease in people living with HIV) have been published in the Journal of the American Medical Association Network Open (JAMA network open). The study found that about half of the study participants, who were considered by traditional measures to be at low to moderate risk for future heart disease, had atherosclerotic plaque in their coronary arteries.

Although it is well known that people living with HIV are at an increased risk of cardiovascular events, including heart attacks and strokes, the prevalence and extent of atherosclerosis in the blood vessels is poorly understood. blood of the heart and associated biological factors. REPRIEVE’s mechanistic substudy was designed to specifically identify factors that contribute to cardiovascular disease in people living with HIV.

“This REPRIEVE sub-study seeks to better understand why people living with HIV develop heart disease, even when their HIV is well controlled and they do not have many traditional risk factors,” said the president. from ACTG, Judith Currier, MD, MSc, University of California, Los Angeles. “REPRIEVE is the largest study on cardiovascular disease in people living with HIV and this is an important first report that sets the stage for important future discoveries.”

Today’s post describes baseline data on 755 participants aged 40 to 75, who were enrolled at 31 sites across the United States. The substudy used coronary angiography to assess the amount of plaque in participants’ coronary arteries, then correlated these findings with blood samples measuring inflammation and immune activation.

Almost half of the participants (49 percent) had plaque in their coronary arteries, although the plaque was mostly seen in a few areas of the coronary arteries. The presence of plaque was associated with a higher burden of risk factors, but also with higher levels of inflammation independent of traditional risk scores. In almost all of the individuals (97 percent), the plaque was mild and did not cause more than 50 percent narrowing of the coronary artery. While significant shrinkage was rare, about a quarter of participants (23%) had plaque with features that could potentially cause problems in the future (also known as vulnerable plaque).

In the general population, epidemiological studies have shown that future cardiovascular disease increases with higher ASCVD PCE (Pooled Cohort Equation for Atherosclerotic Cardiovascular Disease) risk scores, a traditional risk index. REPRIEVE recruited participants with a low to moderate ASCVD risk and a low 10-year mean risk score of 4.5 percent. The clinical significance of mild or even severe plaque in asymptomatic people at low cardiovascular risk is unknown, as is the effectiveness of statin therapy in preventing cardiovascular disease in this population. REPRIEVE will address these important questions by following these participants to determine whether the plaque reported in the REPRIEVE mechanistic substudy is clinically significant (whether it is linked to future cardiovascular events), whether statin therapy may reduce plaque and markers. inflammation, and whether statin therapy can reduce the incidence of heart attacks and strokes.

“Heart disease is a major cause of illness and death in people living with HIV, including those whose disease is well controlled and receiving antiretroviral therapy,” said Steven Grinspoon, MD, Massachusetts General Hospital. “So far, our understanding of coronary heart disease in people living with HIV has been very limited. These findings significantly expand our knowledge and provide important information that will lay the groundwork to ultimately help us better support the health and well-being of people living with HIV. ”



REPRIEVE (the randomized trial to prevent vascular events in HIV) recruited 7,770 people living with HIV at over 100 sites in 12 countries around the world in collaboration with ACTG and is led by Dr Grinspoon and Michael Lu, MD, MPH, Massachusetts General Hospital, and Harvard Medical School; Pamela Douglas, MD, Duke University; and Heather Ribaudo, Ph.D., Harvard School of Public Health. The REPRIEVE mechanistic substudy was led by Dr Grinspoon and Udo Hoffmann, MD, MPH, Massachusetts General Hospital. REPRIEVE is supported by the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) and National Institute of Allergy and Infectious Diseases (NIAID) as well as by KOWA Pharmaceuticals America, Gilead Sciences and ViiV Healthcare.

About ACTG

Founded in 1987, the AIDS Clinical Trials Group (ACTG) was the world’s first HIV research network. It is funded by NIAID and collaborating NIH institutes. ACTG is leading groundbreaking studies to improve treatment for HIV and its complications, including tuberculosis and viral hepatitis; reduce new infections and HIV-related illnesses; and advancing new approaches to prevent, treat and ultimately cure HIV in adults and children. ACTG investigators and research units in 15 countries are major resources for HIV / AIDS research, treatment, care and training / education in their communities. ACTG studies have helped establish current paradigms for the management of HIV disease and informed HIV treatment guidelines, resulting in dramatic reductions in HIV-related mortality worldwide.

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