Comparative Effectiveness and Toxicity of Statins Among HIV-Infected Patients

Department of Medicine, University of Washington, Seattle, WA 98104, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 02/2011; 52(3):387-95. DOI: 10.1093/cid/ciq111
Source: PubMed


dyslipidemia is common and is often treated with 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins). Little is known about the comparative effectiveness of statins among human immunodeficiency virus (HIV)-infected patients. This study compared the effectiveness and toxicity of statins among HIV-infected patients in clinical care.
we conducted a retrospective cohort study of patients starting their initial statin medications at 2 large HIV clinics (N = 700). The primary observation was change in lipid levels during statin therapy. Secondary observations included whether individualized National Cholesterol Education Program (NCEP) goals for low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) levels were reached, and toxicity rates. We used linear regression to examine change in lipid levels, controlling for baseline lipid values and demographic and clinical characteristics. We conducted secondary analyses using propensity scores to address confounding by indication.
the most commonly prescribed statins were atorvastatin (N = 303), pravastatin (N = 280), and rosuvastatin (N = 95). One year after starting a statin therapy, patients who received atorvastatin or rosuvastatin had significantly greater decreases in total cholesterol, LDL-C, and non-HDL-C than patients on pravastatin. The likelihood of reaching NCEP goals for LDL-C levels was higher with the use of rosuvastatin (OR 2.1; P = .03) and atorvastatin (odds ratio [OR], 2.1; P = .001) compared with that of pravastatin. The likelihood of reaching NCEP goals for non-HDL-C levels was higher for rosuvastatin (OR 2.3; P = .045) but not atorvastatin (OR, 1.5; P = .1) compared with pravastatin. Toxicity rates were similar for all 3 statins: 7.3% for atorvastatin, 6.1% for pravastatin, and 5.3% for rosuvastatin.
our findings suggest that atorvastatin and rosuvastatin are preferable to pravastatin for treatment of HIV-infected patients with dyslipidemia, due to greater declines in total cholesterol, LDL-C, and non-HDL-C, with similar lower toxicity rates.

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    • "This may be due to greater declines in total cholesterol, low density lipoprotein-cholesterol (LDL-C), and non–high density lipoprotein-cholesterol (non–HDL-C), with similar lower toxicity rates. These findings are also consistent with the recent British guidelines that recommend the use of rosuvastatin in HIV patients with dyslipidemia.[27] "
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    ABSTRACT: As newer methods of management are made available, and accessible, survival rates with human immunodeficiency virus (HIV) are increasing. This means that chronic, metabolic complications of HIV are becoming more frequent in clinical practice, as acute morbidity is controlled. Management of HIV/acquired immunodeficiency syndrome (AIDS) is gradually expanding to include these chronic and metabolic complications of the disease, and the adverse effects associated with its treatments, including diabetes. Unfortunately, no guidelines are available to help the medical practitioners choose appropriate therapy for patients with these conditions. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in patients with HIV. The development of these guidelines used systematic reviews of available evidence to form its key recommendations. These guidelines and associated review of literature represent a compilation of available knowledge regarding rational management of diabetes in HIV. Patients of diabetes with concomitant HIV infection are managed optimally with insulin therapy and judicious use of highly active antiretroviral therapy with suitable alternatives is also recommended. These guidelines should prove helpful to physicians, not only in South Asia, but also across the globe, while managing patients with coexistent HIV and diabetes.
    Full-text · Article · Oct 2011
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    Full-text · Article · · Pharmacoepidemiology and Drug Safety
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    ABSTRACT: Dyslipidemia is frequently observed in HIV-infected patients. Its pathogenesis is complex and includes factors related to the virus, the host, and antiretroviral treatment. Dyslipidemia is a main cardiovascular risk factor and it is partially modifiable. Whereas HIV infection and its treatment are associated with a state of accelerated atherosclerosis and an increase in the number of cases of myocardial infarction, dyslipidemia management must be a priority in the clinical care of patients with HIV infection. In this review, we discuss the major pathogenic mechanisms of dyslipidemia associated with antiretroviral therapy and the effect of the currently used drugs on the lipid profile. The current recommendations for dyslipidemia management include the control of other cardiovascular risk factors, the choice of antiretroviral drugs with a better lipid profile, and lipid-lowering drug use when clinically indicated.
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