The Role of Statins in the Setting of HIV Infection

Abstract

HIV-infected individuals are at an increased risk of cardiovascular disease (CVD) and other HIV-related co-morbidities. This is due in part to dyslipidemia associated with antiretroviral therapy and increased inflammation and immune activation from chronic HIV infection. Statins not only have potent lipid-lowering properties but are also anti-inflammatory and immunomodulators. Studies suggest that statin therapy in the HIV-infected population may decrease the risk of CVD and other non-AIDS-defining co-morbidities. This review summarizes the recent literature on statin use in the HIV setting.

A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials investigating the effects of statin therapy on plasma lipid concentrations in HIV-infected patients

“…Indeed, most of the statins interfere with metabolism of anti-retroviral drugs due to the fact that they are metabolized via the cytochrome P450 3A4 isoform, inducing increased toxicity (13). These safety warnings have limited statin therapy in HIV-infected individuals receiving simultaneous antiretroviral therapy (35).…”

“…These safety warnings have limited statin therapy in HIV-infected individuals receiving simultaneous antiretroviral therapy (35). Since pravastatin is a cytochrome P450 independent and water- The mechanism underlying the interactions between pravastatin and anti-retroviral drugs may be due to a competition at the cytochrome level that transports protein P-glycoprotein and may also be caused by genetic polymorphism (13). However, in HIV-infected patients on statin therapy, it has been recommended that plasma concentrations of protease inhibitors be evaluated to avoid drug-drug interaction (38).…”

“…Disruption of lipid rafts due to 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitors reduces HIV-1 particle production (11) but also inhibit lymphocyte function antigen-1 (LFA 1 ), down-regulate Rho activity (12), and have effects on intracellular adhesion molecule-1 (ICAM-1), essential for viral entry and exit (13). The best choice of a pharmacologic agent for HIV patients taking protease inhibitors drugs might be pravastatin, which is not substantially metabolized by cytochrome (CYP) 3A 4 , decreasing the risk of hypothetic drug-drug interactions (14).…”

Statin Therapy Does Not Reduce Liver Fat Scores in Patients Receiving Antiretroviral Therapy for HIV Infection

“…Antiretroviral treatment is known alter lipid levels, and also interact with statin therapy 6 . This means that statins can have different lipid-lowering potencies and immunomodulatory effects in HIVinfected individuals compared to uninfected individuals 7 . Only a single recent small study assessed the effect of atorvastatin on liver fat in a group of HIV-infected individuals with NAFLD and showed an improvement in hepatic steatosis with statin therapy 8 .…”

Significant Decrease in Plasma Levels of D-Dimer, Interleukin-8, and Interleukin-12 After a 12-Month Treatment with Rosuvastatin in HIV-Infected Patients Under Antiretroviral Therapy

“…[9][10][11] Some clinical studies have demonstrated anti-inflammatory and immunomodulatory properties of statins in HIV-infected people too, but data are limited and not always concordant. 12,13 Moreover, data are still lacking about the statin effect on the coagulation markers in HIV-infected patients.…”