Statin Therapy May Reduce Mortality in Patients With HIV Infection: Presented at CROI

By John Schieszer
ATLANTA -- March 7, 2013 -- Statin exposure in patients infected with HIV who are on highly active antiretroviral therapy (HAART) appears to be associated with reductions in non-AIDS complications and mortality, according to results of a survival analysis presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI).
This apparent benefit from statin therapy appears to be greater for HIV-positive patients taking high-potency statins.
Chronic inflammation and immune suppression in this population is known to be associated with increased incidence of non-AIDS complications, such as cardiovascular diseases, malignancies and osteoporotic fractures.
Henning Drechsler, MD, Veterans Administration North Texas Healthcare System, Dallas, Texas, and colleagues examined the impact of cumulative exposure (person-years) of statins in HIV-infected patients on HAART, and discovered a significant benefit, he noted at a presentation here on March 4.
The team examined 25,884 patients with HIV infection who were exposed to HAART. The median follow-up was 6.62 years. They performed a Cox proportional hazards analysis to investigate the association of cumulative exposure to any statin drug and mortality or onset of non-AIDS complications. In addition, they separately analysed the effect of statins among 15,943 virologically suppressed patients only -- patients who achieved viral load of CD4 <400 cells/mm3 following HAART initiation.
The team conducted a separate analysis for individual statins, examining patients on both “potent” statins (rosuvastatin and atorvastatin) and other statins (lovastatin, pravastatin, simvastatin).
The results showed 6,435 deaths and 2,199 cardiovascular-disease incidents (acute myocardial infarction and cerebrovascular accident). There were 5,011 malignancies, 3,196 cases of chronic kidney disease, and 610 osteoporotic fractures.
A multivariate analysis controlled for age, gender, race, body mass index, hypertension, smoking status, low-density lipoprotein levels, and nadir CD4 counts. The researchers identified 171,467 person-years of cumulative exposure to statins among all patients on HAART and 101,813 person-years among the virologically suppressed patients.
Deaths occurred in 37.52 per 1,000 person-years in all patients on HAART and 29.43 per 1,000 person years among the virologically suppressed patients.
There were 13.75 cardiovascular-disease incidents per 1,000 person-years in all patients on HAART and 13.53 among the virologically suppressed patients. There were 36.27 malignancies per 1,000 person-years for all patients on HAART and 34.38 per 1,000 person-years in the virologically suppressed patients. The numbers were similar in terms of fractures as well (3.64 vs 3.70, respectively).
Patients on potent statin therapy experienced lower death rates and lower rates of cardiovascular disease incidents in both groups; the malignancy rates were also lower among the virologically suppressed patients.
“Statin use may be very beneficial in HIV infected people, especially those with comorbidities,” Dr. Drechsler concluded. “[However], there is a concern about drug-drug interactions, and you have to be careful,” he warned.
[Presentation title: Impact of Statin Exposure on Mortality and Non-AIDS Complications in HIV Patients on HAART. Abstract 765]

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