Effectiveness and Safety of Statins on Outcomes in Patients with HIV Infection: A Systematic Review and Meta-Analysis

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.