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Benefits and Risks of Statin Therapy in the HIV-Infected Population

  • HIV/AIDs (C Yoon, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

HIV-infected patients face an increased risk for cardiovascular disease (CVD), estimated at 1.5- to 2-fold as compared to HIV-uninfected persons. This review provides a recent (within preceding 5 years) summary of the role of statin therapy and associated role in CVD risk reduction among HIV-infected patients on anti-retroviral therapy.

Recent Findings

Statins remain the preferred agents for reducing risk for CVD among HIV-infected populations based on guidance extrapolated from general population (HIV-uninfected) cholesterol treatment guidelines across different settings globally. However, HIV-infected patients are consistently under prescribed statin therapy when compared to their HIV-uninfected counterparts. The most commonly studied statins in clinical care and small randomized and cohort studies have been rosuvastatin and atorvastatin. Both agents are preferred for their potent lipid-lowering effects and their favorable or neutral pleotropic effects on chronic inflammation, renal function, and hepatic steatosis among others. However, growing experience with the newer glucuronidated pitavastatin suggests that this agent has virtually no adverse drug interactions with ART or effects on glucose metabolism—all marked additional benefits when compared with rosuvastatin and atorvastatin while maintaining comparable anti-lipid effects. Pitavastatin is therefore the statin of choice for the ongoing largest trial (6500 participants) to test the benefits of statin therapy among HIV-infected adults.

Summary

Statins are underutilized in the prevention of CVD in HIV-infected populations based on criteria in established cholesterol guidelines. There is a potential role for statin therapy for HIV-infected patients who do not meet guideline criteria which will be further delineated through ongoing clinical trials.

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana

    Mosepele Mosepele & Onkabetse J. Molefe-Baikai

  2. Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana

    Mosepele Mosepele

  3. Sir Ketumile Masire Teaching Hospital, Faculty of Medicine, University of Botswana, 3rd Floor, Block F, Room F4069, Gaborone, Botswana

    Mosepele Mosepele

  4. Program in Nutritional Metabolism, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA

    Steven K. Grinspoon

  5. Divisions of Infectious Diseases and General Internal Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA

    Virginia A. Triant

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  1. Mosepele Mosepele
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  2. Onkabetse J. Molefe-Baikai
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  3. Steven K. Grinspoon
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Correspondence to Mosepele Mosepele.

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Mosepele, M., Molefe-Baikai, O.J., Grinspoon, S.K. et al. Benefits and Risks of Statin Therapy in the HIV-Infected Population. Curr Infect Dis Rep 20, 20 (2018). https://doi.org/10.1007/s11908-018-0628-7

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