SAN DIEGO, CA—A study reported at IDWeek 2012 comparing the lipid-lowering efficacy of different statins when coadministered with protease inhibitors or non-nucleoside reverse transcriptase inhibitors in patients with HIV found no significant difference in LDL reduction.
Inhibition of CYP450 by protease inhibitors has the potential to increase toxicity, and its induction by non-nucleoside reverse transcriptase inhibitors may decrease efficacy, each to a different magnitude depending on the statin used, reported Susan Duquaine, PharmD, from the VA North Texas Health Care System, Dallas, and colleagues.
Therefore, deciding what statin to use should be driven by the potential for drug interactions.
Using the system’s computerized patient record system, all patients with HIV infection receiving highly active antiretroviral therapy (HAART) containing protease inhibitors or non-nucleoside reverse transcriptase inhibitors who were coadministered the high-potency statins atorvastatin or rosuvastatin or the low-potency pravastatin were identified.
“Patients were included if they had no changes to their antiretroviral regimen for 4 weeks prior to and anytime after initiation of the statin,” Dr. Duquaine noted. Of the 134 patients who met the inclusion criteria, 68 were receiving non-nucleoside reverse transcriptase inhibitors and 66 were receiving protease inhibitors.
In the non-nucleoside reverse transcriptase inhibitor group, mean age was 55 years, 99% were male, and duration of HIV infection was 11 years; atorvastatin dose was 40mg; rosuvastatin, 10mg; and pravastatin, 20mg. In the protease inhibitor group, mean age was 54 years, 100% were male, and duration of HIV infection was 12 years; atorvastatin dose was 10mg; rosuvastatin, 10mg; and pravastatin, 20mg.
No significant differences were observed in LDL lowering ability from baseline (P=0.33) or LDL goal attainment between high- and low-potency statins in patients taking non-nucleoside reverse transcriptase inhibitors vs. protease inhibitors, she noted.
In addition, no differences were noted in percentage of triglyceride reduction, HIV viral load, CD4 counts, creatinine clearance, and liver toxicity. More incidences of myalgia were noted in the group treated with protease inhibitors (12% vs. 2.9%); however, this was not statistically significant (P=0.097).