Rahman Anita P, Eaton Susan A, Nguyen Sean T, Bain Amy M, Payne Kenna D, Bedimo Roger, Busti Anthony J
School of Pharmacy, Texas Tech University Health Sciences Center, Dallas-Fort Worth Regional Campus, Dallas, Texas 75216, USA.
Pharmacotherapy. 2008 Jul;28(7):913-9. doi: 10.1592/phco.28.7.913.
To evaluate the safety and efficacy of simvastatin for treatment of dyslipidemia in patients with the human immunodeficiency virus (HIV) who were receiving efavirenz-based highly active antiretroviral therapy (HAART), and to evaluate the effect of simvastatin when added to efavirenz on CD4(+) count, HIV viral load, and frequency of attainment of patient-specific National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III lipid goals.
Retrospective medical record review.
Veterans Affairs health care system in Dallas, Texas.
Thirteen HIV-infected men who received a stable efavirenz-based HAART regimen concurrently with simvastatin 20 mg/day, and 19 HIV negative men who received simvastatin 20 mg/day (controls).
Demographic, clinical, and laboratory data were collected before and after starting simvastatin. Reductions in lipid profile values in the HIV-infected group versus HIV-negative group were as follows: total cholesterol -20% versus -28% (p=0.15), low-density lipoprotein cholesterol (LDL) -36% versus -41% (p=0.06), non-high-density lipoprotein cholesterol (non-HDL) -22% versus -33% (p=0.212), and total cholesterol:HDL ratio -33% versus -30% (p=0.26). These effects were seen without any documented adverse drug reactions or changes in viral and immunologic control. However, 28% fewer HIV-infected patients were able to achieve NCEP ATP III LDL goals compared with HIV-negative subjects.
These preliminary comparative data suggest that simvastatin can be safely and effectively used to treat dyslipidemia in HIV-infected patients receiving efavirenz-based HAART without compromising viral or immunologic control. However, our results are suggestive of slight lessening of the LDL-lowering effects, which might be explained by the known reduction in simvastatin levels with efavirenz. Furthermore, fewer HIV-infected patients were able to meet their NCEP ATP III goals compared with HIV-negative controls, highlighting the difficulty in treating this population to current standards of care.
评估辛伐他汀对接受基于依非韦伦的高效抗逆转录病毒疗法（HAART）的人类免疫缺陷病毒（HIV）感染者血脂异常的安全性和疗效，并评估将辛伐他汀添加到依非韦伦中对CD4(+)细胞计数、HIV病毒载量以及达到患者特定的美国国家胆固醇教育计划（NCEP）成人治疗小组（ATP）III血脂目标频率的影响。
回顾性病历审查。
得克萨斯州达拉斯的退伍军人事务医疗保健系统。
13名接受稳定的基于依非韦伦的HAART方案并同时每日服用20mg辛伐他汀的HIV感染男性，以及19名每日服用20mg辛伐他汀的HIV阴性男性（对照组）。
在开始使用辛伐他汀之前和之后收集人口统计学、临床和实验室数据。HIV感染组与HIV阴性组血脂谱值的降低情况如下：总胆固醇 -20% 对 -28%（p = 0.15），低密度脂蛋白胆固醇（LDL）-36% 对 -41%（p = 0.06），非高密度脂蛋白胆固醇（非HDL）-22% 对 -33%（p = 0.212），以及总胆固醇：HDL比值 -33% 对 -30%（p = 0.26）。观察到这些效果时未出现任何有记录的药物不良反应或病毒及免疫控制方面的变化。然而，与HIV阴性受试者相比，能够达到NCEP ATP III LDL目标的HIV感染患者少28%。
这些初步的比较数据表明，辛伐他汀可安全有效地用于治疗接受基于依非韦伦的HAART的HIV感染患者的血脂异常，且不会损害病毒或免疫控制。然而，我们的结果提示LDL降低效果略有减弱，这可能是由于已知依非韦伦会降低辛伐他汀水平所致。此外，与HIV阴性对照组相比，能够达到NCEP ATP III目标的HIV感染患者较少，这突出了按照当前护理标准治疗该人群的困难。
