Statin decreases arterial inflammation, immune activation in patients with HIV

Pitavastatin resulted in greater reductions of markers of arterial inflammation and immune activation compared with pravastatin among patients with HIV and dyslipidemia, according to study results presented at ASM Microbe 2016.

Pitavastatin (Livalo, Kowa Pharmaceuticals), which has previously been shown to reduce low-density lipoprotein, does not appear to have significant interactions with ART. The presentation at ASM Microbe focused on changes in markers of arterial inflammation and immune activation, including soluble CD14, oxidized low-density lipoprotein and lipoprotein-associated phospholipase A2.

The researchers randomly assigned 252 patients who had been on ART for more than 6 months (CD4 > 200 cells µL; HIV RNA < 200 copies/mL) 1:1 to 4 mg pitavastatin or 40 mg pravastatin every day by mouth. Biomarkers of inflammation were measured at 12 and 52 weeks.

There were no differences in age, sex, BMI, log HIV RNA, Framingham risk score and baseline markers of inflammation between treatment groups. Patients in the pitavastatin arm demonstrated greater reductions in soluble CD14 (P = .01), oxidized low-density lipoprotein (P = .02) and lipoprotein-associated phospholipase A2 (P = .01).

Pitavastatin is also being studied in the Randomized Trial to Prevent Vascular Events in HIV, or REPRIEVE, trial. Steven K. Grinspoon, MD, a co-principal investigator on the REPRIEVE trial, spoke with Infectious Disease News about the potential benefits of statin therapy in patients with HIV. Grinspoon is professor of medicine at Harvard Medical School, director of the Massachusetts General Hospital Program in Nutritional Metabolism and co-director of the Nutrition Obesity Research Center at Harvard.

“We all agree that ART should be started as soon as possible in patients with HIV. However, recent data suggest that, even if you start ART early and achieve a significant reduction in viral load, you still have persistent inflammation,” he said.

The aim of REPRIEVE, and other studies examining the use of statins in patients with HIV, is to determine whether statins prevent heart disease and other events related to inflammation in these patients, according to Grinspoon.

“Hopefully, with this statin therapy – or, if not this statin, then other agents – we can reduce the ongoing, residual immune activation and reduce related events among patients with HIV,” he said. – by Julia Ernst, MS

Reference:

Fitch K, et al. Effects of pitavastatin on markers of arterial inflammation and immune activation in HIV patients. Presented at: ASM Microbe; June 16-20, 2016; Boston.

Disclosure: Fitch reports no relevant financial disclosures. Grinspoon reports receiving research funding from KOWA Pharmaceuticals. Please see the full studies for a list of all other researchers’ relevant financial disclosures.