Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults
- Registration Number
- NCT02344290
- Brief Summary
People with HIV are at risk for cardiovascular disease (CVD). This study evaluated the use of pitavastatin to reduce the risk of CVD in adults with HIV on antiretroviral therapy (ART).
The REPRIEVE trial consisted of two parallel identical protocols:
* REPRIEVE (A5332) was funded by the NHLBI, with additional infrastructure support provided by the NIAID, and was conducted in U.S and select international sites (approximately 120 sites in 11 countries).
* REPRIEVE (EU5332) was co-sponsored by NEAT ID and MGH, and was conducted at 13 sites in Spain.
- Detailed Description
There are few strategies to prevent CVD in people with HIV (PWH), even though they are at high risk for developing CVD. Statin medications are used to lower cholesterol and may be effective at reducing the risk of CVD in PWH. The purpose of this study was to evaluate the use of pitavastatin to reduce the risk of CVD in PWH on ART.
This study enrolled PWH who were on any ART regimen (ART was not provided by the study) for at least 6 months before study entry and were at low to moderate risk of CVD using the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guideline thresholds for recommended statin initiation.
Participants were randomly assigned to receive 4 mg of pitavastatin or placebo once a day for their entire study duration. Pitavastatin or placebo could be discontinued and clinically indicated statin therapy initiated at the discretion of the site investigator or the participant's care provider, with the intention of following the participant according to the intention-to-treat trial design. Study visits occurred at study entry and Months 1 and 4. Starting at Month 4, study visits occurred every 4 months for the rest of the study. Depending on when participants enrolled, they were in the study for a total of 4 to 8 years. Study visits included medical and medication history reviews, physical examinations, blood collections, assessments and questionnaires, urine collections (for some participants), and an electrocardiogram (ECG) (at study entry only).
Participants at US sites had the option of enrolling in a substudy (Effects of Pitavastatin on Coronary Artery Disease and Inflammatory Biomarkers: Mechanistic Substudy of REPRIEVE \[A5333s\]). The substudy evaluated the effect of pitavastatin on the progression of non-calcified coronary atherosclerotic plaque (NCP) and inflammatory biomarkers in PWH. Participants in the substudy attended study visits at study entry and Months 4 and 24. The visits included questionnaires and assessments, a blood collection, and a coronary computed tomography angiography (CCTA). The Mechanistic Substudy closed to accrual on February 6, 2018, when its accrual target of 800 participants had been reached. Sites that enrolled participants into the Mechanistic Substudy are indicated with asterisk (\*) at the end of the institution names in the Contacts and Locations section.
Participants enrolled in REPRIEVE from select study sites, including international sites, through December, 2017, were included in the REPRIEVE Kidney Function Objectives Cohort to evaluate the effects of pitavastatin on parameters of kidney function in the setting of HIV. These objectives include evaluating high risk groups and mechanisms driving kidney function decline in the setting of HIV.
Women and men enrolled in REPRIEVE after February, 2016 were included in an observational cohort (REPRIEVE Women's Objectives Cohort) facilitating assessment of sex-specific mechanisms of CVD risk and risk reduction among PWH. This effort also included an evidence-based recruitment campaign to enhance women's participation in REPRIEVE.
In response to the SARS-CoV-2 pandemic, a supplemental objective was added in 2020. To better understand how COVID-19 affects PWH and if pitavastatin may reduce the risk of serious COVID-19 disease, we evaluated interrelated but independent key topics including epidemiology, host factors, and protective strategies. Starting from April 2020, COVID-19 assessment was completed at each study visit, and blood was collected for COVID-19 biomarkers.
The data and safety monitoring board (DSMB) recommended stopping the trial for efficacy at the second planned review on March 30, 2023, and concluded that no unexpected safety concerns had been reported. Following the DSMB action, participants were asked to return for the final study visit. All final visits were completed by August 21, 2023. We here present the results based on the final trial database, including the full follow-up out to closeout visits.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 7769
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Individual with HIV-1
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Combination antiretroviral therapy (ART) for at least 180 days prior to study entry
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CD4+ cell count greater than 100 cells/mm^3
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Acceptable screening laboratories including:
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Fasting low-density lipoprotein (LDL) cholesterol as follows:
- If ASCVD risk score was less than 7.5%, LDL cholesterol must have been less than 190 mg/dL.
- If ASCVD risk score was greater than or equal to 7.5% and less than or equal to 10%, LDL must have been less than 160 mg/dL.
- If ASCVD risk score was greater than 10% and less than or equal to 15%, LDL must have been less than 130 mg/dL.
- Participants with LDL less than 70 mg/dL were eligible regardless of the 10-year ASCVD risk score, in line with the ACC/AHA 2013 Prevention Guidelines.
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Fasting triglycerides less than 500 mg/dL
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Hemoglobin greater than or equal to 8 g/dL for female participants and greater than or equal to 9 g/dL for male participants
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Glomerular filtration rate (GFR) greater than or equal to 60 mL/min/1.73m^2 or creatinine clearance (CrCl) greater than or equal to 60 mL/min
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Alanine aminotransferase (ALT) less than or equal to 2.5 x the upper limit of normal (ULN)
-
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For persons with known chronic active hepatitis B or C, calculated fibrosis 4 score (FIB-4) must have been less than or equal to 3.25
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Ability and willingness of participant or legal representative to provide written informed consent
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Clinical ASCVD, as defined by 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, including a previous diagnosis of any of the following:
- Acute myocardial infarction (AMI)
- Acute coronary syndromes
- Stable or unstable angina
- Coronary or other arterial revascularization
- Stroke
- Transient ischemic attack (TIA)
- Peripheral arterial disease presumed to be of atherosclerotic origin
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Current diabetes mellitus with LDL greater than or equal to 70 mg/dL
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10-year ASCVD risk score estimated by Pooled Cohort Equations greater than 15%
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Active cancer within 12 months prior to study entry, except successfully treated non-melanomatous skin cancer and Kaposi sarcoma without visceral organ involvement
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Known decompensated cirrhosis
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History of myositis or myopathy with active disease in the 180 days prior to study entry
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Known untreated symptomatic thyroid disease
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History of allergy or severe adverse reaction to statins
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Use of specific immunosuppressants or immunomodulatory agents including but not limited to tacrolimus, sirolimus, rapamycin, mycophenolate, cyclosporine, tumor necrosis factor (TNF)-alpha blockers or antagonists, azathioprine, interferon, growth factors, or intravenous immunoglobulin (IVIG) in the 30 days prior to study entry.
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Current use of erythromycin, colchicine, or rifampin
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Use of any statin drugs, gemfibrozil, or PCSK9 inhibitors in the 90 days prior to study entry
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Current use of an investigational new drug that would be contraindicated
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Serious illness or trauma requiring systemic treatment or hospitalization in the 30 days prior to study entry
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Current pregnancy or breastfeeding
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Alcohol or drug use that, in the opinion of the site investigator, would interfere with completion of study procedures
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Other medical, psychiatric, or psychological condition that, in the opinion of the site investigator, would interfere with completion of study procedures and or adherence to study drug
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pitavastatin Pitavastatin Participants received pitavastatin once a day for the entire time they were in study follow-up. Placebo Placebo Participants received placebo for pitavastatin once a day for the entire time they were in study follow-up.
- Primary Outcome Measures
Name Time Method Incidence Rate of Major Adverse Cardiovascular Event (MACE) From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). MACE is a composite of cardiovascular (CV) death, myocardial infarction, hospitalization for unstable angina, stroke, transient ischemic attack (TIA), peripheral arterial ischemia, coronary, carotid or peripheral arterial revascularization, or death from an undetermined cause. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Non-CV deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
- Secondary Outcome Measures
Name Time Method For Mechanistic Substudy: HsCRP Level Entry and month 24. Level of inflammatory marker high-sensitivity C-reactive protein (HsCRP). Censored values below or above the assay limit were imputed. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Cardiac Ischemia or Myocardial Infarction From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Cardiac ischemia or myocardial infarction component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Cerebrovascular Event (Stroke or TIA) From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Cerebrovascular event (stroke or TIA) component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Peripheral Arterial Ischemia From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Peripheral arterial ischemia component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Death From CV Causes From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). CV death component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Non-CV deaths and deaths from undetermined causes were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Death From CV or Undetermined Causes From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). CV or undetermined death component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Non-CV deaths were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Cardiac Catheterization or Revascularization From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Cardiac cardiac catheterization or revascularization component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Carotid or Cerebrovascular Revascularization From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Carotid or cerebrovascular revascularization component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Peripheral Arterial Revascularization From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Peripheral arterial revascularization component of the primary composite MACE outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of MACE or Death From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). A composite outcome including MACE and death from any cause. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Death (All-cause) From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Death from any cause. The incidence rates were estimated based on time to event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Non-CV Clinical Diagnoses From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). A composite of non-CV clinical diagnoses including: non-AIDS-defining cancers (excluding basal cell and squamous cell carcinomas of the skin), AIDS-defining events (based on Centers for Disease Control and Prevention \[CDC\] 2014 classification), end-stage renal disease, and end-stage liver disease. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Non-AIDS-defining Cancer From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Non-AIDS-defining cancer (excluding basal cell and squamous cell carcinomas of the skin) component of the composite non-CV clinical diagnoses outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of AIDS-defining Event From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). AIDS-defining event component of the composite non-CV clinical diagnoses outcome. Events were captured based on the Centers for Disease Control and Prevention \[CDC\] 2014 classification. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of End-Stage Renal Disease From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). End-stage renal disease (defined as initiation of dialysis or renal transplantation) component of the composite non-CV clinical diagnoses outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of End-Stage Liver Disease From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). End-stage liver disease (defined as cirrhosis or hepatic decompensation requiring hospitalization) component of the composite non-CV clinical diagnoses outcome. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated via cause-specific relative hazard (i.e. hazard ratio) of prescribed pitavastatin compared to placebo from Cox proportional hazards models, stratified by screening CD4 count and sex. Deaths (without preceding event of interest) were treated as competing events and censored. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Non-fatal Serious Adverse Event From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of non-fatal serious adverse event was defined by International Conference on Harmonisation (ICH) criteria. Fatal events were excluded as deaths were a secondary efficacy outcome (see outcome measure: incidence rate of death (all-cause)). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo), adjusted for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Diabetes From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of diabetes was defined as new diagnosis of diabetes with initiation of anti-diabetic agent. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo), adjusted for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Myalgia, Muscle Weakness or Myopathy From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of myalgia, muscle weakness or myopathy which were grade 3 or higher or treatment-limiting. Grade 3 or higher includes grade 3 and 4 events, where grade 3 refers to severe and grade 4 to life-threatening according to DAIDS AE Grading Table (version 2.1). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo), adjusted for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Change in Total Plaque Volume From Baseline to Year 2 Entry and year 2. Total plaque includes all plaque voxels (noncalcified + calcified). Change in total plaque volume is expressed as absolute change from baseline (calculated as volume at 2 years minus volume at entry). Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: LpPLA2 Level Entry and month 24. Level of inflammatory biomarker lipoprotein-associated phospholipase A2 (LpPLA2). Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Rhabdomyolysis From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of rhabdomyolysis which was grade 3 or higher or treatment-limiting. Grade 3 or higher includes grade 3 and 4 events, where grade 3 refers to severe and grade 4 to life-threatening, according to DAIDS AE Grading Table (version 2.1). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo). Due to small number of events, there was no adjustment for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Grade 3 or Higher ALT From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of Grade 3 or higher alanine transaminase (ALT). Grade 3 or higher includes grade 3 and 4 events, where grade 3 refers to severe and grade 4 to life-threatening, according to DAIDS AE Grading Table (version 2.1). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo). Due to small number of events, there was no adjustment for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Adverse Event (AE) From entry through end of study. Follow-up time varied depending on time of enrollment (the median follow-up time was 5.6 years). Safety analysis outcome measure of any AE. AE collection included events of grade ≥3, those that were serious (defined by International Conference on Harmonisation (ICH) criteria) or treatment-limiting, and targeted diagnosis of diabetes. Grade ≥3 includes events that were grade 3 (serious) or grade 4 (life-threatening) per DAIDS AE Grading Table (version 2.1). Fatal events were excluded as deaths were a secondary efficacy outcome (see outcome measure: incidence rate of death (all-cause)). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo), adjusted for screening CD4 and sex. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Fasting Low-density Lipoprotein Cholesterol (LDL-C) At entry and months 12, 24, 36, 48, 60, 72, 84. Participants' follow-up time on study varied, depending on their time of enrollment. LDL-C level was derived as LDL-C calculated according to the Friedewald formula at triglycerides ≤400 mg/dL, and direct LDL-C at triglycerides \>400 to \<500 mg/dL. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Fasting Non-high-density Lipoprotein Cholesterol (Non-HDL-C) At entry and months 12, 24, 36, 48, 60, 72, 84. Participants' follow-up time on study varied, depending on their time of enrollment. Non-HDL cholesterol levels were calculated as total cholesterol minus HDL cholesterol. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of Serious COVID-19 From January 1, 2020 through end of study; the median follow-up time was 3.3 years. Serious COVID-19 was defined as COVID-19 that resulted in hospitalization or death or was life-threatening as per the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use Guideline E2A definition. The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios from Poisson regression models (prescribed pitavastatin compared to placebo), adjusted for GBD region to account for regional differences. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Incidence Rate of COVID-19 From January 1, 2020 through end of study; the median follow-up time was 3.3 years. COVID-19 was defined as COVID-19 clinical diagnosis or positive test result (SARS-CoV-2 PCR or rapid antigen tests). The incidence rates were estimated based on time to the first event using Poisson distribution, with follow-up time censored at last contact. The treatment effect was estimated using incidence rate ratios (prescribed pitavastatin compared to placebo) from Poisson regression models, adjusted for GBD region to account for regional differences. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Change in Non-Calcified Plaque (NCP) Volume From Baseline to Year 2 Entry and Year 2. NCP was defined as plaque voxels with attenuation of \<350. Change in NCP is expressed as absolute change from baseline (calculated as NCP volume at 2 years minus NCP volume at entry), based on quantitative read of the CT scan, whenever available. Participants without a quantitative read and no evidence of NCP based on the corresponding qualitative read were assigned a value of zero for the change. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Number of Participants With Progression of NCP From Baseline to Year 2 Entry and year 2. Progression at Year 2 was defined as any progression/increase in NCP volume in participants with evidence of NCP at entry, or incident NCP in participants without evidence of NCP at entry. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Change in LpPLA2 From Baseline Entry and month 24. Change in inflammatory biomarker LpPLA2 from baseline calculated as value at month 24 minus value at entry. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Change in HsCRP From Baseline Entry and month 24. Change in inflammatory biomarker hsCRP from baseline calculated as value at month 24 minus value at entry. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Soluble CD163 Level Entry and month 24. Level of immune biomarker soluble CD163. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
For Mechanistic Substudy: Change in Soluble CD163 From Baseline Entry and month 24. Change in immune biomarker soluble CD163 from baseline calculated as value at month 24 minus value at entry. Treatment discontinuation was ignored, including the initiation of statin therapy as part of clinical care (intention to treat policy).
Trial Locations
- Locations (137)
Alabama CRS*
🇺🇸Birmingham, Alabama, United States
University of Southern California CRS*
🇺🇸Los Angeles, California, United States
UCLA CARE Center CRS*
🇺🇸Los Angeles, California, United States
UCSD Antiviral Research Center CRS*
🇺🇸San Diego, California, United States
Ucsf Hiv/Aids Crs*
🇺🇸San Francisco, California, United States
Harbor-UCLA CRS*
🇺🇸Torrance, California, United States
University of Colorado Hospital CRS*
🇺🇸Aurora, Colorado, United States
Northwestern University CRS*
🇺🇸Chicago, Illinois, United States
Rush University CRS*
🇺🇸Chicago, Illinois, United States
Johns Hopkins University CRS*
🇺🇸Baltimore, Maryland, United States
Massachusetts General Hospital CRS (MGH CRS)*
🇺🇸Boston, Massachusetts, United States
Brigham and Women's Hospital Therapeutics Clinical Research Site (BWH TCRS) CRS*
🇺🇸Boston, Massachusetts, United States
Washington University Therapeutics (WT) CRS*
🇺🇸Saint Louis, Missouri, United States
New Jersey Medical School Clinical Research Center CRS*
🇺🇸Newark, New Jersey, United States
Mount Sinai Beth Israel CRS*
🇺🇸New York, New York, United States
Weill Cornell Chelsea CRS*
🇺🇸New York, New York, United States
Mount Sinai Downtown CRS*
🇺🇸New York, New York, United States
Mount Sinai West Samuels CRS*
🇺🇸New York, New York, United States
Mount Sinai St. Luke's Morningside CRS*
🇺🇸New York, New York, United States
Columbia P&S CRS*
🇺🇸New York, New York, United States
Weill Cornell Uptown CRS*
🇺🇸New York, New York, United States
University of Rochester Adult HIV Therapeutic Strategies Network CRS*
🇺🇸Rochester, New York, United States
Chapel Hill CRS*
🇺🇸Chapel Hill, North Carolina, United States
Greensboro CRS*
🇺🇸Greensboro, North Carolina, United States
Cincinnati Clinical Research Site*
🇺🇸Cincinnati, Ohio, United States
Case Clinical Research Site*
🇺🇸Cleveland, Ohio, United States
Ohio State University CRS*
🇺🇸Columbus, Ohio, United States
Penn Therapeutics, CRS*
🇺🇸Philadelphia, Pennsylvania, United States
University of Pittsburgh CRS*
🇺🇸Pittsburgh, Pennsylvania, United States
The Miriam Hospital Clinical Research Site (TMH CRS) CRS*
🇺🇸Providence, Rhode Island, United States
Vanderbilt Therapeutics (VT) CRS*
🇺🇸Nashville, Tennessee, United States
Houston AIDS Research Team CRS*
🇺🇸Houston, Texas, United States
University of Washington AIDS CRS*
🇺🇸Seattle, Washington, United States
Puerto Rico AIDS Clinical Trials Unit CRS*
🇵🇷San Juan, Puerto Rico
University of Arizona CRS
🇺🇸Tucson, Arizona, United States
Mills Clinical Research CRS
🇺🇸Los Angeles, California, United States
VA West Los Angeles Medical Center CRS
🇺🇸Los Angeles, California, United States
Los Angeles LGBT Center CRS
🇺🇸Los Angeles, California, United States
Eisenhower Health Center at Rimrock CRS
🇺🇸Palm Springs, California, United States
Stanford AIDS Clinical Trials Unit CRS
🇺🇸Palo Alto, California, United States
Denver Public Health CRS
🇺🇸Denver, Colorado, United States
Yale University CRS
🇺🇸New Haven, Connecticut, United States
VA Connecticut Healthcare System CRS
🇺🇸West Haven, Connecticut, United States
Whitman-Walker Health CRS
🇺🇸Washington, District of Columbia, United States
Georgetown University CRS (GU CRS)
🇺🇸Washington, District of Columbia, United States
Capital Medical Associates, PC CRS
🇺🇸Washington, District of Columbia, United States
Infectious Diseases Clinic, Washington DC Veterans Affairs Medical Center CRS
🇺🇸Washington, District of Columbia, United States
Malcom Randall VA Medical Center CRS
🇺🇸Gainesville, Florida, United States
AHF-The Kinder Medical Group CRS
🇺🇸Miami, Florida, United States
The University of Miami AIDS Clinical Research Unit (ACRU) CRS
🇺🇸Miami, Florida, United States
University of Miami Infectious Disease Research Unit at Jackson Memorial Hospital CRS
🇺🇸Miami, Florida, United States
AHF - South Beach CRS
🇺🇸Miami, Florida, United States
Orlando Immunology Center CRS
🇺🇸Orlando, Florida, United States
Community AIDS Network/Comprehensive Care Clinic CRS
🇺🇸Sarasota, Florida, United States
Florida Department of Health - Hillsborough County
🇺🇸Tampa, Florida, United States
AIDS Research and Treatment Center of the Treasure Coast CRS
🇺🇸Vero Beach, Florida, United States
The Ponce de Leon Center CRS
🇺🇸Atlanta, Georgia, United States
Augusta University Research Institute, Inc. CRS
🇺🇸Augusta, Georgia, United States
UIC Project WISH CRS
🇺🇸Chicago, Illinois, United States
Indiana University Infectious Diseases Research CRS
🇺🇸Indianapolis, Indiana, United States
Department of Internal Medicine, University of Iowa Hospitals & Clinics CRS
🇺🇸Iowa City, Iowa, United States
Bluegrass Care Clinic/University of Kentucky Research Foundation CRS
🇺🇸Lexington, Kentucky, United States
550 Clinic -University of Louisville CRS
🇺🇸Louisville, Kentucky, United States
Tulane - Louisiana Community AIDS Research Program (T-LaCARP) CRS
🇺🇸New Orleans, Louisiana, United States
Tufts Medical Center CRS
🇺🇸Boston, Massachusetts, United States
Boston Medical Center CRS
🇺🇸Boston, Massachusetts, United States
Baystate Infectious Diseases Clinical Research CRS
🇺🇸Springfield, Massachusetts, United States
Henry Ford Hosp. CRS
🇺🇸Detroit, Michigan, United States
St. John Newland Medical Associates CRS
🇺🇸Southfield, Michigan, United States
Abbott Northwestern Hospital CRS
🇺🇸Minneapolis, Minnesota, United States
University of Mississippi Medical Center CRS
🇺🇸Jackson, Mississippi, United States
Specialty Care Center CRS
🇺🇸Omaha, Nebraska, United States
Cooper Univ. Hosp. CRS
🇺🇸Camden, New Jersey, United States
James J Peters VA Medical Center CRS
🇺🇸Bronx, New York, United States
VA New York Harbor Healthcare System (NYHHS), NY Campus CRS
🇺🇸New York, New York, United States
Infectious Disease Clinical and Translational Research Center (CTRC) CRS
🇺🇸New York, New York, United States
Duke University Medical Center CRS
🇺🇸Durham, North Carolina, United States
Wake Forest Baptist Medical Center CRS
🇺🇸Winston-Salem, North Carolina, United States
University of Toledo Medical Center CRS
🇺🇸Toledo, Ohio, United States
Oklahoma State University Center for Health Sciences CRS
🇺🇸Tulsa, Oklahoma, United States
Division of Infectious Diseases Clinical Research Center- Drexel University CRS
🇺🇸Philadelphia, Pennsylvania, United States
Center of Translational AIDS Research, Lewis Katz School of Medicine at Temple University CRS
🇺🇸Philadelphia, Pennsylvania, United States
Positive Health Clinic CRS
🇺🇸Pittsburgh, Pennsylvania, United States
Medical University of South Carolina: Division of Infectious Diseases CRS
🇺🇸Charleston, South Carolina, United States
Prisma Health CRS
🇺🇸Columbia, South Carolina, United States
Trinity Health and Wellness Center CRS
🇺🇸Dallas, Texas, United States
Dallas VA Medical Center CRS
🇺🇸Dallas, Texas, United States
UT Southwestern HIV/ID Clinical Trials Unit CRS
🇺🇸Dallas, Texas, United States
Michael E. DeBakey VAMC REPRIEVE CRS
🇺🇸Houston, Texas, United States
Inova Heart and Vascular Institute CRS
🇺🇸Falls Church, Virginia, United States
Virginia Commonwealth University CRS
🇺🇸Richmond, Virginia, United States
Medical College of Wisconsin, Inc. CRS
🇺🇸Milwaukee, Wisconsin, United States
Gaborone CRS
🇧🇼Gaborone, South-East District, Botswana
Tropical Medicine Foundation Dr. Heitor Vieira Dourado CRS
🇧🇷Manaus, Amazonas, Brazil
School of Medicine, Federal University of Minas Gerais CRS
🇧🇷Belo Horizonte, Minas Gerais, Brazil
HGNI HIV Family Care Clinic - HHFCC CRS
🇧🇷Nova Iguacu, Rio De Janeiro, Brazil
Hospital Nossa Senhora da Conceicao CRS
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Centro de Referencia e Treinamento DST/AIDS CRS
🇧🇷Sao Paulo, São Paulo, Brazil
Projeto Praça Onze Pesquisa em Saúde CRS
🇧🇷Rio de Janeiro, Brazil
Hospital Federal dos Servidores do Estado CRS
🇧🇷Rio de Janeiro, Brazil
Instituto de Pesquisa Clinica Evandro Chagas (IPEC) CRS
🇧🇷Rio de Janeiro, Brazil
Instituto de Infectologia Emilio Ribas CRS
🇧🇷Sao Paulo, Brazil
Centro de Pesquisas Clínicas IC-HCFMUSP CRS
🇧🇷Sao Paulo, Brazil
Vancouver ID Research & Care Centre Society CRS
🇨🇦Vancouver, British Columbia, Canada
Hamilton Health Sciences - Special Immunology Services Clinic CRS
🇨🇦Hamilton, Ontario, Canada
Maple Leaf Research CRS
🇨🇦Toronto, Ontario, Canada
Toronto General Hospital CRS
🇨🇦Toronto, Ontario, Canada
Chronic Viral Illness Service CRS
🇨🇦Montreal, Quebec, Canada
Centre hospitalier de l'Université Laval CRS
🇨🇦Quebec City, Quebec, Canada
GHESKIO Institute of Infectious Diseases and Reproductive Health (GHESKIO - IMIS) CRS
🇭🇹Port-au-Prince, Haiti
Les Centres GHESKIO Clinical Research Site (GHESKIO-INLR) CRS
🇭🇹Port-au-Prince, Haiti
Byramjee Jeejeebhoy Medical College (BJMC) CRS
🇮🇳Pune, Maharashtra, India
Chennai Antiviral Research and Treatment (CART) CRS
🇮🇳Chennai, Tamil Nadu, India
Barranco CRS
🇵🇪Lima, Peru
San Miguel CRS
🇵🇪Lima, Peru
Soweto ACTG CRS
🇿🇦Johannesburg, Gauteng, South Africa
Wits Helen Joseph Hospital CRS (Wits HJH CRS)
🇿🇦Johannesburg, Gauteng, South Africa
Durban International Clinical Research Site CRS
🇿🇦Durban, Kwa Zulu Natal, South Africa
University of Cape Town Lung Institute (UCTLI) CRS
🇿🇦Cape Town, Western Cape Province, South Africa
Famcru Crs
🇿🇦Tygerberg, Western Cape Province, South Africa
Hospital General Universitario de Alicante
🇪🇸Alicante, Spain
Hospital Germans Trias i Pujol
🇪🇸Badalona, Spain
Hospital Universitario Valle d'Hebron
🇪🇸Barcelona, Spain
Hospital Clinic de Barcelona
🇪🇸Barcelona, Spain
Hospital Universitario de Bellvitge
🇪🇸Barcelona, Spain
Hospital Universitario de Basurto de Basurto
🇪🇸Bilbao, Spain
Hospital General Universitario De Elche
🇪🇸Elche, Spain
Hospital Gregorio Universitario Maranon
🇪🇸Madrid, Spain
Hospital Universitario Ramon y Cajal
🇪🇸Madrid, Spain
Hospital Universitario Clinico San Carlos
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Universitario Virgen de la Victoria
🇪🇸Málaga, Spain
Thai Red Cross AIDS Research Centre (TRC-ARC) CRS
🇹🇭Bangkok, Thailand
Chiang Mai University HIV Treatment (CMU HIV Treatment) CRS
🇹🇭Chiang Mai, Thailand
Joint Clinical Research Centre (JCRC)/Kampala Clinical Research Site
🇺🇬Kampala, Uganda
Milton Park CRS
🇿🇼Harare, Zimbabwe