Which Statins Are Best for Treating HIV-Related Dyslipidemia?

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Summary and CommentWhich Statins Are Best for Treating HIV-Related Dyslipidemia?In an observational study, atorvastatin and rosuvastatin were more effective than pravastatin, with similar toxicity rates.Dyslipidemia is common in HIV-infected patients and is typically characterized by high LDL cholesterol levels, high triglyceride levels, and low HDL cholesterol levels. Statins are the main agents used to reduce LDL levels, but little is known about their comparative effectiveness in HIV-infected patients.To address this issue, investigators reviewed data from 700 HIV-infected patients who initiated statin therapy between 2000 and 2008. The cohort (85% men; mean age, 43) had an average 10-year cardiovascular risk of 10% and an average CD4-count nadir of 182 cells/mm3. Forty-three percent were receiving protease inhibitors, and 25% were receiving nonnucleoside reverse transcriptase

inhibitors; the remainder were not on antiretroviral therapy.The most commonly used statins were atorvastatin (303 patients), pravastatin (280), and rosuvastatin (95). The median initial and final doses used during the study period were 10 and 20 mg for atorvastatin, 20 and 40 mg for pravastatin, and 5–10 and 10 mg for rosuvastatin.At 1 year, patients on atorvastatin or rosuvastatin had significantly greater decreases in total, LDL, and non-HDL cholesterol levels than patients taking pravastatin. The mean declines in LDL cholesterol levels according to statin were 26, 23, and 12 mg/dL, respectively, and the mean declines in trigylceride levels were 60, 83, and 24 mg/dL. HDL cholesterol changes were minimal for all three statins.The odds of reaching National Cholesterol Education Program (NCEP) goals for LDL were significantly higher with atorvastatin and rosuvastatin than with pravastatin; the odds of reaching such goals for non-HDL cholesterol were significantly higher only with rosuvastatin. Overall, 6.4% of patients experienced toxicity necessitating statin discontinuation; this rate was similar across the various statins.Comment: This study adds considerably to the body of literature describing outcomes of statin use in the setting of HIV infection. Guidelines published some time ago in the U.S. have favored use of pravastatin because of the potential for fewer drug–drug interactions, but the clinical outcomes data from this study might reasonably lead to a shift toward atorvastatin or rosuvastatin. The fact that one third of all patients failed to meet NCEP goals at 12 months and that 6.4% had to discontinue all statins because of toxicity underscores the present difficulty of managing dyslipidemia in HIV-infected persons.— Henry,

MDPublished in Journal Watch HIV/AIDS Clinical Care January 14, 2011Citation(s):Singh S et al. Comparative effectiveness and toxicity of statins among HIV-infected patients. Clin Infect Dis 2011 Feb 1; 52:387.Original article (Subscription may be required)Medline abstract (Free) Regards, VergelPoWeRUSA.org