Statin use in HIV-positive patients
Satyajit Das, HIV i-Base
The effectiveness and adverse events related to statins among HIV-positive patients was investigated by Singh and colleagues from University of Washington, Seattle, in an observational cohort study of all patients in two large clinical settings.
Over 700 patients starting their first statin were followed for a median of 19 months. Prescribed statins included atorvastatin (n=303), pravastatin (n=280), and rosuvastatin (n=98).
One year after starting statins, after controlling for baseline lipid values, and demographic and clinical characteristics, patients on atorvastatin and rosuvastatin had a significantly greater decrease in TC (-14.5 and -18.0 mg/dL, both p<0.001) and LDL (-14.0 and -11.2 mg/dL, both p<0.02) than those on pravastatin. Patients on rosuvastatin had a greater decline in triglyceride levels. Adverse event rates were similar for atorvastatin (4.6%), pravastatin (4.2%), and rosuvastatin (3.9%). NCEP target levels for LDL at 1 year were achieved by 68% on atorvastatin and 69% on rosuvastatin vs 55% on pravastatin (p=0.01).
The authors concluded “Despite large reductions, many patients did not reach a target goal. Evaluation of the safety and effectiveness of additional lipid lowering agents like ezetemibe or fibrates needs further exploration”.
Singh et al. Effectiveness of individual HMG CoA reductase inhibitors (Statins) in HIV-infected patients in clinical care. 48th ICAAC, 25-28 October 2008. Washington. Abstract H-2303.