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Effects of Pitavastatin on COVID-19 Incidence and Seriousness Among a Global Cohort of People With HIV
- Zanni, Markella V;
- Umbleja, Triin;
- Fichtenbaum, Carl J;
- Fitch, Kathleen V;
- McCallum, Sara;
- Aberg, Judith A;
- Overton, Edgar Turner;
- Malvestutto, Carlos D;
- Bloomfield, Gerald S;
- Currier, Judith S;
- Schnittman, Samuel R;
- Erlandson, Kristine M;
- Diggs, Marissa R;
- Foldyna, Borek;
- Martinez, Esteban;
- Somboonwit, Charurut;
- Wang, Gary P;
- Mushatt, David;
- Connick, Elizabeth;
- Lu, Michael T;
- Douglas, Pamela S;
- Ribaudo, Heather J;
- Grinspoon, Steven K
Published Web Location
https://doi.org/10.1093/ofid/ofae574Abstract
Background
Among people with HIV (PWH), COVID-19 is common and potentially severe. We leveraged REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) to assess the effects of statin therapy for cardiovascular disease prevention on COVID-19 outcomes (incidence and serious cases) among a global cohort of PWH.Methods
COVID-19 data collection was implemented April 2020 to capture events from January 2020. COVID-19 was defined by positive test result or clinical diagnosis and serious COVID-19 according to the International Conference on Harmonisation definition. Among participants in follow-up on 1 January 2020, Cox proportional hazards modeling was used to estimate the hazard ratio (HR) of COVID-19 (pitavastatin/placebo), stratified by Global Burden of Disease region. Modification of statin effect following COVID-19 vaccination was evaluated via interaction with time-updated vaccination status.Results
Among 6905 PWH, 32% were natal female and 41% were Black or African American. The median age was 53 years and the 10-year atherosclerotic cardiovascular disease risk score 4.5%. Statin therapy did not reduce COVID-19 incidence (HR, 1.05; 95% CI, .95-1.15) but appeared to reduce incidence of serious COVID-19 (HR, 0.75; 95% CI, .52-1.09). Among 1701 PWH with COVID-19, the relative risk (pitavastatin/placebo) for serious COVID-19 was 0.73 (95% CI, .52-1.03). The treatment effect size for serious COVID-19 fell within the hypothesized range, but the 95% CI crossed 1 given fewer-than-anticipated cases (117 vs 200). Furthermore, 83% reported COVID-19 vaccination by end of study, with a strong protective effect on serious COVID-19 (HR, 0.27; 95% CI, .14-.53; P < .0001). A protective statin effect was observed prior to vaccination.Conclusions
Among PWH, statin therapy had no effect on COVID-19 incidence but showed potential to reduce risk of serious COVID-19 prior to COVID-19 vaccination.Clinical trials registration
NCT02344290 (ClinicalTrials.gov).Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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