Question
Should I start taking statins?
21 March 2012. Related: All topics.
Hi,
I am 54 and have been positive for almost three years.
I choose to start treatment five months ago and went undetectable shortly afterwards and my CD4 is currently 595, I am taking isentress and truvada.
I read with interest information about statins and am considering asking my consultant to go on them.
If I do start to take a statin which one would you recommend is best for me.
I read that the benefits of statins are cholesterol-lowering (my last cholesterol result was 4.1), reduced immune activation and inflammation and a significant reduction in the risk of some cancers.
What I am not sure about are the side effects/harm statins can do and whether the long term use will significantly adversely affect my quality of life.
Any information you can give would be very welcome. Thanks
Answer
Hello,
Thank-you for your question.
Statins are a family of drugs commonly used in people with high cholesterol levels. In HIV positive people they are often used to combat increased lipid levels as a side effect of some types of ARVs.
Firstly I’d like to ask why it is that you are interested in taking statins? Your cholesterol levels (4.1) are very healthy and not something to be worried about. As the main use of statins is to reduce cholesterol it is unlikely your doctor would recommend adding these drugs to your treatment at this time.
You mention the potential of statins to reduce immune activation. It is true that some studies have found the use of high-dose statins can reduce immune activation in treatment naïve patients. ‘Treatment naïve’ means patients who have never taken ARVs and are not doing so currently. As this does not apply to you it is unclear what added benefit statins could in this way.
Although statins are not commonly reported as having severe side effects there are some reported adverse symptoms. These can include fatigue, myalgias/arthralgias (joint pain) and gastrointestinal problems. As with all medications statins should only be prescribed if the perceived benefits outweigh risks of negative effects.
You also asked which statin would be best for you. As the following paragraph from the BHIVA guidelines shows, this is not a simple question. The statins that are easiest to take with ARVs, are also the least potent:
Pravastatin and fluvastatin have the least potential for drug interaction but are relatively less potent lipid-lowering agents. Atorvastatin can be used but caution should be exercised in patients taking Pls, as extensive safety data are lacking. Rosuvastatin is very potent but should be used with caution as blood levels can increase with ritonavir. Simvastatin and lovastatin are contraindicated in patients taking Pls. With NNRTIs, higher dose of statins may be needed.
I have attached links to a number of articles that discuss statins at the end of this email. The first is the BHIVA guidelines- if you look at section 9.0 you will see information on which statins are recommended for HIV+ people. I have also included links to two trials: the first looks at the effectiveness and toxicity of these drugs in HIV+ people; the second looks at claims of alternative benefits beyond lipid reductions.
BHIVA Guidelines
‘Comparative Effectiveness and Toxicity of Statins Among HIV-Infected Patients’
Unintended effects of statins in men and women in England and Wales
Comment