Safety and Efficacy of Simvastatin for the Treatment of Dyslipidemia in Human Immunodeficiency Virus‐Infected Patients Receiving Efavirenz‐Based Highly Active Antiretroviral Therapy

Abstract

These preliminary comparative data suggest that simvastatin can be safely and effectively used to treat dyslipidemia in HIV-infected patients receiving efavirenz-based HAART without compromising viral or immunologic control. However, our results are suggestive of slight lessening of the LDL-lowering effects, which might be explained by the known reduction in simvastatin levels with efavirenz. Furthermore, fewer HIV-infected patients were able to meet their NCEP ATP III goals compared with HIV-negative controls, highlighting the difficulty in treating this population to current standards of care.

Impact of Efavirenz on Intestinal Metabolism and Transport: Insights From an Interaction Study With Ezetimibe in Healthy Volunteers

“…From the therapeutic point of view, the combination of efavirenz and ezetimibe may be a promising therapeutic option in HIV-infected patients with hypercholesterolemia. In contrast to described drug interactions with statins, 11,12 we observed no clinically relevant influence of efavirenz on the disposition and lipid-lowering effect of ezetimibe. With reference to this, monotherapy with ezetimibe was shown to be an equivalent therapeutic option in clinical practice.…”

“…5,[7][8][9][10] However, the lipid-lowering effect of several statins was shown to be significantly reduced after comedication with efavirenz. 11,12 The reason for this interaction is most likely activation of the nuclear constitutive androstane receptor (CAR), for which efavirenz is a potent activator in vitro and in vivo. [13][14][15][16][17] With CAR-type enzyme induction, efavirenz may regulate several drug metabolizing enzymes and transporter proteins that are involved in the disposition of statins (e.g., CYP3A4, ABCB1, and ABCC2) and in its own pharmacokinetics (auto-induction of CYP3A4 and CYP2B6).…”

Use of HMG-CoA Reductase Inhibitors in the HIV Population: Implications for Individualized Treatment Selection

“…30 Etravirine is an inducer of CYP3A, but an inhibitor of CYP2C9, CYP2C19, and P-glycoprotein. Efavirenz, nevirapine, and etravirine have the potential to decrease plasma concentrations of statins and thus lead to a reduced lipid-lowering response.…”

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.…”