Statin Therapy for HIV-Positive Patients
Are statins safe and effective for human immunodeficiency virus (HIV)-positive patients?
For this meta-analysis, studies were identified through a search of MEDLINE/PubMed, Cochrane Library, Biomed Central, and Google Scholar for articles published in English. Articles had to report studies which included HIV-positive patients treated with statins for primary prevention with 6 or more weeks of follow-up. Studies were excluded if they were nonhuman, duplicate reporting, and 75% of patients were on combination antiretroviral therapy (cART). A total of 236 citations were identified, of which 18 were included in this meta-analysis. In these studies, statins used included pravastatin, rosuvastatin, atorvastatin, fluvastatin, and simvastatin. The primary endpoint was the effect of statin therapy on total cholesterol (TC) levels.
A total of 736 patients were included, of whom 21.0% were female, with a median age of 44.1 years and a mean body mass index of 23.9 kg/m2. At baseline, median CD4+ cell count was 521 cells/mm3, mean time from HIV diagnosis was 106.0 months, and average duration of cART exposure was 65.0 months. The median follow-up was 12 weeks. All patients were on cART: 76.5% on protease inhibitor (PI)-containing regimens, 29.8% on one non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen, and 16.2% on NRTI-sparing regimens. Rosuvastatin 10 mg and atorvastatin 10 mg provided the largest reduction in TC levels (mean 21.67, 95% confidence interval [CI] [21.99, 21.35] mmol/L; and mean 21.44, 95% CI [21.85, 21.02] mmol/L, respectively). Atorvastatin 80 mg and simvastatin 20 mg provided the largest reduction in low-density lipoprotein (LDL) (mean 22.10, 95% CI [23.39, 20.81] mmol/L; and mean 21.57, 95% CI [22.67, 20.47] mmol/L, respectively). Pravastatin 10–20 mg and atorvastatin 10 mg had the largest increase in high-density lipoprotein. Atorvastatin 80 mg and simvastatin 20 mg had the largest reduction in triglycerides. NNRTI-sparing regimens were associated with reduced efficacy for statins to lower TC.
The investigators concluded that statin therapy lowers TC and LDL levels among HIV-positive patients and is associated with lower rates of adverse events.
This meta-analysis supports the use of statin therapy for HIV-positive patients as primary cardiovascular disease prevention.
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