Department of Medicine, University of Washington, Seattle, WA 98104, USA.
Clin Infect Dis. 2011 Feb 1;52(3):387-95. doi: 10.1093/cid/ciq111. Epub 2010 Dec 28.
dyslipidemia is common and is often treated with 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins). Little is known about the comparative effectiveness of statins among human immunodeficiency virus (HIV)-infected patients. This study compared the effectiveness and toxicity of statins among HIV-infected patients in clinical care.
we conducted a retrospective cohort study of patients starting their initial statin medications at 2 large HIV clinics (N = 700). The primary observation was change in lipid levels during statin therapy. Secondary observations included whether individualized National Cholesterol Education Program (NCEP) goals for low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) levels were reached, and toxicity rates. We used linear regression to examine change in lipid levels, controlling for baseline lipid values and demographic and clinical characteristics. We conducted secondary analyses using propensity scores to address confounding by indication.
the most commonly prescribed statins were atorvastatin (N = 303), pravastatin (N = 280), and rosuvastatin (N = 95). One year after starting a statin therapy, patients who received atorvastatin or rosuvastatin had significantly greater decreases in total cholesterol, LDL-C, and non-HDL-C than patients on pravastatin. The likelihood of reaching NCEP goals for LDL-C levels was higher with the use of rosuvastatin (OR 2.1; P = .03) and atorvastatin (odds ratio [OR], 2.1; P = .001) compared with that of pravastatin. The likelihood of reaching NCEP goals for non-HDL-C levels was higher for rosuvastatin (OR 2.3; P = .045) but not atorvastatin (OR, 1.5; P = .1) compared with pravastatin. Toxicity rates were similar for all 3 statins: 7.3% for atorvastatin, 6.1% for pravastatin, and 5.3% for rosuvastatin.
our findings suggest that atorvastatin and rosuvastatin are preferable to pravastatin for treatment of HIV-infected patients with dyslipidemia, due to greater declines in total cholesterol, LDL-C, and non-HDL-C, with similar lower toxicity rates.
血脂异常很常见，通常用 3-羟基-3-甲基戊二酰基辅酶 A（HMG CoA）还原酶抑制剂（他汀类药物）进行治疗。对于感染人类免疫缺陷病毒（HIV）的患者，他汀类药物的比较效果知之甚少。本研究比较了在临床护理中感染 HIV 的患者使用他汀类药物的效果和毒性。
我们对 2 家大型 HIV 诊所（N=700）开始使用初始他汀类药物的患者进行了回顾性队列研究。主要观察指标是他汀类药物治疗期间血脂水平的变化。次要观察指标包括是否达到个体化国家胆固醇教育计划（NCEP）的低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（非-HDL-C）目标以及毒性发生率。我们使用线性回归来检查脂质水平的变化，同时控制基线脂质值和人口统计学及临床特征。我们使用倾向评分进行了二次分析，以解决指示性混杂问题。
最常开的他汀类药物是阿托伐他汀（N=303）、普伐他汀（N=280）和罗苏伐他汀（N=95）。开始他汀类药物治疗一年后，接受阿托伐他汀或罗苏伐他汀治疗的患者的总胆固醇、LDL-C 和非-HDL-C 水平显著降低，而接受普伐他汀治疗的患者则不然。与普伐他汀相比，使用罗苏伐他汀（比值比[OR]，2.1；P=.03）和阿托伐他汀（OR，2.1；P=.001）达到 NCEP 低密度脂蛋白胆固醇水平目标的可能性更高。与普伐他汀相比，使用罗苏伐他汀（OR，2.3；P=.045）而不是阿托伐他汀（OR，1.5；P=.1）达到 NCEP 非高密度脂蛋白胆固醇水平目标的可能性更高。所有 3 种他汀类药物的毒性发生率相似：阿托伐他汀为 7.3%，普伐他汀为 6.1%，罗苏伐他汀为 5.3%。
由于总胆固醇、LDL-C 和非-HDL-C 水平下降更大，毒性发生率相似，我们的研究结果表明，阿托伐他汀和罗苏伐他汀优于普伐他汀，可用于治疗 HIV 感染合并血脂异常的患者。
