Are HIV+ patients resistant to statin therapy?

This was a post on the yahoo group pozhealth from Nelson Vergel. As the piece suggests, statin therapy for people with HIV can be a more complex treatment choice than it is for the HIV negative.

 

We suggest that readers also keep in mind the information on Niacin + statin combination therapy, as presented recently in this Blog (see the “Niacin” category).

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Lipids Health Dis. 2007 Oct 24;6(1):27 [Epub ahead of print]

Are HIV+ patients resistant to statin therapy?

Johns KW, Bennett MT, Bondy GP.

ABSTRACT: BACKGROUND: Patients with HIV are subject to development of HIV metabolic syndrome characterized by dyslipidemia, lipodystrophy and insulin resistance secondary to highly active antiretroviral therapy (HAART). Rosuvastatin is a highly potent HMG-CoA reductase inhibitor. Rosuvastatin is effective at lowering LDL and poses a low risk for drug-drug interaction as it does not share the same metabolic pathway as HAART drugs. This study sought to determine the efficacy of rosuvastatin on lipid parameters in HIV positive patients with HIV metabolic syndrome. RESULTS: Mean TC decreased from 6.54 to 4.89 mmol/L (25.0% reduction, p<0.001). Mean LDL-C decreased from 3.39 to 2.24 mmol/L (30.8% reduction, p<0.001). Mean HDL rose from 1.04 to 1.06 mmol/L (2.0% increase, p=ns). Mean triglycerides decreased from 5.26 to 3.68 mmol/L (30.1% reduction, p<0.001). Secondary analysis examining the effectiveness of rosuvastatin monotherapy (n=70) vs. rosuvastatin plus fenofibrate (n=43) showed an improvement of 21.3% in TG and a decrease of 4.1% in HDL-C in the monotherapy group. The rosuvastatin plus fenofibrate showed a greater drop in triglycerides (45.3%, p<0.001) and an increase in HDL of 7.6% (p=0.08). CONCLUSIONS: This study found that rosuvastatin is effective at improving potentially atherogenic lipid parameters in HIV-positive patients. The lipid changes we observed were of a smaller magnitude compared to non-HIV subjects. Our results are further supported by a small, pilot trial examining rosuvastatin effectiveness in HIV who reported similar median changes from baseline of -21.7% (TC), -22.4% (LDL-C), -30.1% (TG) with the exception of a 28.5% median increase in HDL. In light of the results revealed by this pilot study, clinicians may want to consider a possible resistance to statin therapy when treating patients with HIV metabolic syndrome.

 

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