Efficacy of Pravastatin in Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) and Protease Inhibitor (PI)-based HAART in HIV-Infected Patients

Abstract

Pravastatin has generally been considered a safe and effective option for HIV-infected patients on highly active antiretroviral therapy (HAART). However, pravastatin concentrations are known to significantly decrease with concomitant efavirenz (EFV) use. Currently there are no studies determining if these reductions in pravastatin possibly translate into an attenuation of its lipid lowering efficacy when used in HIV-infected patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. To evaluate the differences in the lipid lowering efficacy of pravastatin for the treatment of dyslipidemia in HIV-infected patients on NNRTI-based HAART compared to protease inhibitor (PI)-based regimens. A single center, retrospective evaluation of a comprehensive electronic HIV registry that identified HIV-infected, Veterans Affairs (VA) patients who received pravastatin 20 mg plus NNRTI or PI-based HAART from January 1997 to November 2006 who met the strict criteria for inclusion. A total of 18 patients [NNRTI (n = 7) and PI (n = 11)] met the strict criteria for inclusion. In HIV-infected patients taking NNRTI-based HAART there was a reduction in TC by -10.1%, LDL by -12% and non-HDL by -12.2% within 6 months after starting pravastatin 20 mg. In HIVinfected patients taking PI-based HAART, there was a reduction in TC by -10.1%, in LDL by -21.1% and in non-HDL by -13.8% within 6 months after starting pravastatin 20 mg. In both groups, only one additional patient achieved their patient specific lipid goals. In either group these reductions were seen without any apparent adverse drug events or compromise to virologic or immunologic control. This initial evaluation suggests that pravastatin's efficacy may be attenuated with NNRTIs versus PI-based HAART, possibly due to known reductions in pravastatin concentrations when administered with NNRTI-based regimens. These effects were seen without any apparent compromises to safety and should be validated in a prospective study.

A Multimodal, Evidence‐Based Approach to Achieve Lipid Targets in the Treatment of Antiretroviral‐Associated Dyslipidemia: Case Report and Review of the Literature

“…Emerging data and clinical experience suggest that lipid-lowering responses might be blunted in patients receiving HAART. [26][27][28] Although reasons for this resistance have not been fully elucidated, they may represent an interplay between an underlying metabolic process and the dysmetabolic effects of the antiretrovirals themselves. We do know that pharmacokinetic drug interactions may explain this blunted effect, at least in part.…”

A Formalized Teaching, Practice, and Research Partnership with the Veterans Affairs North Texas Health Care System: A Model for Advancing Academic Partnerships

“…One of the focus areas has been the management of dyslipidemias in patients infected with human immunodeficiency virus (HIV). [9][10][11][12][13][14][15] These studies have helped provide guidance for the best practices to utilize when caring for HIV-positive patients with dyslipidemias. The inclusion of VANTHCS in a multicenter evaluation of vancomycin that focused on dosing for obese patients led to the development of a vancomycin dosing and monitoring team at VANTHCS.…”