{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:03:31Z","timestamp":1788185011472,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The REPRIEVE study demonstrated significant reductions in major adverse cardiovascular events (MACE) with pitavastatin among people living with HIV (PWH) with low to moderate cardiovascular risk. Most MACE events occurred in higher\u2010income countries, raising important considerations for similar primary prevention interventions within HIV programmes in low\u2010 and middle\u2010income countries (LMICs) as antiretrovirals become safer and as PWH age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Limited data from Africa and within REPRIEVE suggests that MACE may not be as prevalent among PWH as within other geographies. Consequently, there remain questions about the appropriateness of extrapolating REPRIEVE data to the region and whether it should motivate programmatic implementation on the continent. Moreover, glucose and lipid screening used in REPRIEVE raise concerns about additional resources for similar screening, where there is little existing infrastructure and subsequent treatment. Similarly, questions around funding priorities, and health worker resource allocation for MACE prevention, particularly in the context of competing health priorities and limited health financing, need to be addressed. Newer cardiovascular medications, with cardiac, renal, hepatic, diabetes and weight loss benefits, may have greater promise, although cost remains a major concern. Finally, successful implementation with statins or other proven interventions will be unlikely, unless systemic change within non\u2010communicable disease health system delivery programmes occurs first. However, HIV programmes and public health systems more generally have shown themselves to be poor at screening and treating other cardiovascular risk factors, including aspects as simple as raised blood pressure, even in high\u2010income countries, and statins remain grossly under\u2010prescribed for primary and secondary prevention internationally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>REPRIEVE turned a spotlight on how ill\u2010prepared current HIV programmes are to implement the simplest and safest primary care prevention interventions for cardiometabolic disease within LMICs. As data for existing and new interventions become available, HIV delivery systems will need to raise their standard beyond simply prescribing antiretrovirals and taking viral loads.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26525","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T05:05:52Z","timestamp":1749618352000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["REPRIEVE final results: What does it mean for guidelines in low\u2010 and middle\u2010income countries?"],"prefix":"10.1002","volume":"28","author":[{"given":"Simiso","family":"Sokhela","sequence":"first","affiliation":[{"name":"Wits Ezintsha Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9295-0035","authenticated-orcid":false,"given":"Jennifer M.","family":"Manne\u2010Goehler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samanta","family":"Lalla\u2010Edward","sequence":"additional","affiliation":[{"name":"Wits Ezintsha Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Siedner","sequence":"additional","affiliation":[{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"},{"name":"Clinical Research Department Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"Faculty of Medicine University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed K.","family":"Ali","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health Rollins School of Public Health Emory University  Atlanta Georgia USA"},{"name":"Department of Family and Preventive Medicine School of Medicine Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine Liverpool University  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-365X","authenticated-orcid":false,"given":"Aaloke","family":"Mody","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine St. Louis School of Medicine Washington University  St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Pozniak","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital and London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Nel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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