Rosuvastatin, atorvastatin improved lipid levels in patients with HIV

**Singh S. Clin Infect Dis.2010;1-9.**

Issue: February 2011

When compared with pravastatin, rosuvastatin and atorvastatin significantly improved lipid levels and led to lower toxicity rates in patients with HIV, according to new findings published in Clinical Infectious Diseases.

Researchers pooled data on 700 HIV-infected patients aged 18 or older from two Centers for AIDS Research Network of Integrated Clinical Systems. Patients initiated statins between 2000 and 2008 and were followed until statin discontinuation, changed statin, added another lipid-lowering agent, were lost from data, or until May 1, 2008 — whichever came first.

Linear regression was used to track changes in lipid levels during statin therapy, and to control for baseline lipid values and demographic and clinical characteristics. Propensity scores were used to determine whether individualized National Cholesterol Education Program (NCEP) goals for low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) levels were reached.

Atorvastatin (Lipitor, Pfizer) was most prescribed (n=303), followed by pravastatin (Pravachol, Selektine, TEVA Pharmaceuticals) (n=280), and rosuvastatin (Crestor, Astra Zeneca) (n=95). The remaining 22 patients received other statins.

After 1 year of statin therapy use, patients assigned atorvastatin or rosuvastatin had significant decreases in total cholesterol, LDL-C and non-HDL-C. Patients were most likely to reach NCEP goals for LDL-C levels with rosuvastatin (OR=2.1; P=.03) and atorvastatin (OR=2.1; P=.001) when compared with those on pravastatin.

Moreover, rosuvastatin, was most effective when compared to paravastatin for reaching NCEP goals for non-HDL-C levels (OR=2.3; P=.045 vs. OR=1.5; P=.1). Toxicity rates for all three statins were comparable: 7.3% for atorvastatin, 6.1% for pravastatin, and 5.3% for rosuvastatin.

“Our findings suggest that atorvastatin and rosuvastatin are preferable to pravastatin for treatment of HIV-infected patients with dyslipidemia, due to greater declines in total cholesterol, LDL-C, and non-HDC-L, with similar lower toxicity rates,” researchers wrote.

In contemporary populations of individuals infected with HIV, severe dyslipidemias are common and there is a substantial burden of cardiovascular disease. There is thus tremendous need for and potential for primary and secondary prevention. HIV infected patients are on complex medication regimens, however, and there is reluctance in the medical community to treat with statins other than pravastatin for fear of toxicity due to drug/drug interactions. This retrospective study of 700 patients with HIV infection and dyslipidemia who were treated with statins shows that the more potent statins, atorvastatin and rosuvastatin, had a greater impact on the lipid profile in HIV-infected patients than pravastatin. This is an expected finding. The more important result is that toxicity rates overall were quite low and toxicity rates did not differ between the 3 statins. The study thus suggests that the more potent statins at low doses can be used safely, at least in large, closely supervised HIV clinics, and provide greater benefit than pravastatin which many would have considered the "default statin" / "standard of care" in this population. A retrospective, non-randomized study in specialized centers of care comes with the usual caveats: there was undoubtedly selection bias in that these individuals were chosen to receive statins (compared to their counterparts who were not treated), there is confounding by indication for the choice of statins (addressed here by propensity modeling), and results may not be generalizable to non-tertiary care settings where resources for monitoring therapy may not be as available. Nevertheless, this study suggests that more intensive treatment of dyslipidemia can be accomplished without undue toxicity and should be offered to individuals with HIV infection who are at risk of cardiovascular events.

–Vera Bittner, MD, MSPH

Professor of Medicine, Section Head, Preventive Cardiology, University of Alabama

Diclosure: Dr. Bittner reports no relevant financial disclosures.

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