Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus-positive patients: a systematic review and meta-analysis

Abstract

The efficacy and safety of different statins for human immunodeficiency virus (HIV)-positive patients in the primary prevention setting remain to be established. In the present meta-analysis, 18 studies with 736 HIV-positive patients receiving combination antiretroviral therapy (cART) and treated with statins in the primary prevention setting were included (21.0% women, median age 44.1 years old). The primary endpoint was the effect of statin therapy on total cholesterol (TC) levels. Rosuvastatin 10 mg and atorvastatin 10 mg provided the largest reduction in TC levels [mean -1.67, 95% confidence interval (CI) (-1.99, -1.35) mmol/L; and mean -1.44, 95% CI (-1.85, -1.02) mmol/L, respectively]. Atorvastatin 80 mg and simvastatin 20 mg provided the largest reduction in low-density lipoprotein (LDL) [mean -2.10, 95% CI (-3.39, -0.81) mmol/L; and mean -1.57, 95% CI (-2.67, -0.47) mmol/L, respectively]. Pravastatin 10-20 mg [mean 0.24, 95% CI (0.10, 0.38) mmol/L] and atorvastatin 10 mg [mean 0.15, 95% CI (0.007, 0.23) mmol/L] had the largest increase in high-density lipoprotein, whereas atorvastatin 80 mg [mean -0.60, 95% CI (-1.09, -0.11) mmol/L] and simvastatin 20 mg [mean -0.61, 95% CI (-1.14, -0.08) mmol/L] had the largest reduction in triglycerides. The mean discontinuation rate was 0.12 per 100 person-years [95% CI (0.05, 0.20)], and was higher with atorvastatin 10 mg [26.5 per 100 person-years, 95% CI (-13.4, 64.7)]. Meta-regression revealed that nucleoside reverse transcriptase inhibitors-sparing regimens were associated with reduced efficacy for statin's ability to lower TC. Statin therapy significantly lowers plasma TC and LDL levels in HIV-positive patients and is associated with low rates of adverse events. Statins are effective and safe when dose-adjusted for drug-drug interactions with cART.

HIV-1–Associated Atherosclerosis

“…More recent studies have focused on therapies that reduce immune activation, as well as cholesterol, which may be of benefit, particularly for HIV + individuals because the CVD is driven by traditional and inflammatory factors (3,123). Statins, which are both lipid-lowering and anti-inflammatory, were used in the INTREPID (HIV+ Patients and Treatment with Pitavastatin vs Pravastatin for Dyslipidemia) and the current REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial.…”

“…Recent trials (127) indicate that rosuvastatin decreases oxLDL levels early after initiation and is associated with decreased monocyte activation (3,123). This early improvement in oxLDL is linked with improved CIMT, a measurement for atherosclerotic plaque in treated HIV infection (3,123).…”

“…This early improvement in oxLDL is linked with improved CIMT, a measurement for atherosclerotic plaque in treated HIV infection (3,123). There has been a report of a positive effect of rosuvastatin in reducing LDL levels without a substantial modification of activated T cells and levels of CRP, a general immune marker (128).…”

Gestione del rischio cardiovascolare nel paziente HIV positivo

“…Una recente meta-analisi ha valutato l'efficacia e la tollerabilità delle statine in 736 pazienti HIV-positivi sottoposti a cART e inclusi in 18 trials clinici. Le statine sono risultate efficaci e ben tollerate quando il loro dosaggio era corretto in base alle potenziali interazioni con la cART e la maggiore efficacia nel ridurre i livelli del colesterolo totale è stata evidenziata dalla rosuvastatina a 10 mg/die e dall'atorvastatina a 10 mg/die (42). C'è una sufficiente evidenza scientifica che nella popolazione generale le statine possono rallentare la progressione della malattia aterosclerotica e ridurre l'incidenza di eventi cardiovascolari, non solo tramite la loro azione ipolipemizzante, ma anche attraverso un effetto anti-infiammatorio e immuno-modulatorio.…”

Prospects of the statin treatment: Review of current studies

“…Снижение уровня ЛПНП было максимальным при приеме аторва-статина 80 мг и симвастатина 20 мг; повышение уровня ЛПВП наблюдалось в группах правастатина 10-20 мг и аторвастатина 10 мг. Частота прекращения приема пре-парата была максимальной для аторвастатина [36].…”