Atorvastatin and rosuvastatin have most favourable impact on lipids of patients with HIV

Atorvastatin and rosuvastatin have the biggest impact on lipid levels in HIV-positive patients, a US study published in the February 1^st edition of Clinical Infectious Diseases shows.

Investigators compared the impact of atorvastatin, pravastatin and rosuvastatin on the lipid profiles of 700 HIV-positive adults. More favourable results were seen in patients treated with atorvastatin and rosuvastatin. The safety of the three drugs was comparable, and the rates of serious side-effects and treatment discontinuation because of toxicity were low.

“HIV-infected patients in clinical care who received rosuvastatin or atorvastatin had greater declines in total cholesterol, LDL-C, triglycerides, and non-HDL C values than those patients who received pravastatin,” comment the investigators, who also note “the greatest improvements in dyslipidemia was observed among those who received rosuvastatin.”

Increased blood lipids are common in HIV-positive patients and can increase the long-term risk of serious illnesses such as cardiovascular disease. Guidelines recommend the use of statins to treat high lipids in patients with HIV. However, there is currently little information about the comparable safety and effectiveness of individual statins when used in this population.

Investigators from the University of Alabama and the University of Washington, Seattle, therefore performed a retrospective study including HIV-positive adults who were treated with statins between 2000 and 2008. The impact of the most commonly used statins on lipid profiles was compared. The safety of the drugs was also analysed.

Most of the patients (86%) were men, and the mean age when statin therapy was started was 43 years.

The three most commonly prescribed statins were atorvastatin (43%), pravastatin (40%) and rosuvastatin (14%).

Median starting doses were 10 mg for atorvastatin, 20 mg for pravastatin and between 5 and 10 mg for rosuvastatin. By the end of the study, median doses were 20 mg for atorvastatin, 40 mg for pravastatin and 10 mg for rosuvastatin.

Treatment with the statins improved the patients’ lipid profiles.

After twelve months, mean total cholesterol had fallen by 15%, LDL-cholesterol by 13%, triglycerides by 20% and non-HDL-cholesterol by 17%.

However, outcomes were better for those taking atorvastatin and rosuvastatin than for patients treated with pravastatin. Total cholesterol was significantly lower in patients taking these drugs, as was LDL-cholesterol, and non-HDL cholesterol.

Compared to those taking pravastatin, individuals treated with rosuvastatin also had significantly greater falls in triglycerides (p = 0.03).

After twelve months of therapy 71% of patients had met national US guidelines for cholesterol control.

But once again, outcomes differed according to the statin patients were taking.

Those treated with rosuvastatin (p = 0.03) and atorvastatin (p = 0.001) were significantly more likely than those taking pravastatin to reach the target for LDL-cholesterol reduction.

In addition, those treated with rosuvastatin were more likely than individuals taking pravastatin (p = 0.045) to reach the non-HDL-cholesterol reduction target.

Treatment was generally safe and well tolerated. Overall 6% of patients stopped statin therapy because of side-effects, and the rates of discontinuation did not differ significantly between the three drugs.

Side-effects were reported by 44 patients, and 15 (2%) had potentially serious changes in their liver or kidney function.

Traditionally, pravastatin has been the preferred statin for use in HIV-positive patients. This is because of its low risk of interactions with antiretrovirals. “However,” write the investigators, “our findings suggest that the lipid-lowering effectiveness of pravastatin was significantly less than that of rosuvastatin or atorvastatin.”

The investigators conclude, “our findings are consistent with the recent British guidelines that include a recommendation to use rosuvastatin.”