Statins are hypolipidaemic in human immunodeficiency virus (HIV) positive individuals. However, their effect on all-cause mortality and rate of discontinuation is unclear. We conducted a systematic review to evaluate the impact of statins on all-cause mortality, discontinuation rates, and risk of adverse effects among HIV patients on highly active antiretroviral therapy (HAART). We searched four electronic databases from inception until October 2021 for trials and cohort studies evaluating the effects of statin treatment versus placebo in HIV patients. Forty-seven studies involving 91,594 patients were included. Statins were associated with significantly lower risk of discontinuation (RR, 0.701; 95% CI 0.508–0.967; p = 0.031). The risk of all-cause mortality (RR, 0.994; 95% CI 0.561–1.588; p = 0.827), any adverse effects (RR, 0.780; 95% CI 0.564–1.077; p = 0.131) and, diabetes mellitus (RR, 0.272; 95% CI 0.031–2.393; p = 0.241) with statin treatment were lower but not statistically significant compared to placebo/control. Statin treatment was associated with a trend of higher but statistically insignificant risk of myalgia (RR, 1.341; 95% CI 0.770–2.333; p = 0.299), elevated creatine kinase (RR, 1.101; 95% CI 0.457–2.651; p = 0.830) and liver enzyme activities (RR, 1.709; 95% CI 0.605–4.831; p = 0.312). Clinicians should consider the nocebo effect in the effective management of PLWH on statins, who present with common adverse effects such as myalgia and, elevated levels of creatine kinase and liver enzymes.

No abstract

Statins are hypolipidaemic in human immunodeficiency virus (HIV) positive individuals. However, their all-cause mortality and discontinuation rates improvement is unclear. We evaluated statins impact on all-cause mortality, discontinuation rates, and adverse effects incidence among HIV patients on highly active antiretroviral therapy (HAART). We searched four electronic databases from inception until October 2021 for trials and cohort studies in HIV patients evaluating statins versus placebo. Forty-seven studies involving 91,594 patients were included. Statins significantly decreased discontinuation rates (RR, 0.701; 95% CI, 0.508–0.967; p = 0.031), but insignificantly reduced all-cause mortality (RR, 0.994; 95% CI, 0.561–1.588; p = 0.827). Also, statins insignificantly lowered the incidence of any adverse effects (RR, 0.780; 95% CI, 0.564–1.077; p = 0.131), diabetes mellitus (RR, 0.272; 95% CI, 0.031–2.393; p = 0.241) and raised the incidence of myalgia (RR, 1.341; 95% CI, 0.770–2.333; p = 0.299), and elevated creatine kinase (RR, 1.101; 95% CI, 0.457–2.651; p = 0.830) and liver enzyme (RR, 1.709; 95% CI, 0.605–4.831; p = 0.312) activities. In HAART-experienced patients, statins reduced discontinuation rates and had comparable effects on all-cause mortality with placebo. Furthermore, statin therapy did not increase the onset of any adverse effects, myalgia, elevated creatine kinase and liver enzyme activities, and decrease the onset of diabetes mellitus.