Calza Leonardo, Magistrelli Eleonora, Colangeli Vincenzo, Borderi Marco, Contadini Ilaria, Bon Isabella, Re Maria Carla, Viale Pierluigi
aUnit of Infectious Diseases, Department of Medical and Surgical Sciences bUnit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
AIDS. 2017 Mar 13;31(5):681-688. doi: 10.1097/QAD.0000000000001397.
Several studies have shown a significant association between vitamin D deficiency and an increased risk of statin-related symptomatic myalgia in the general population, but there are no data among HIV-infected persons.
A retrospective, cohort study was conducted to assess the incidence of symptomatic myalgia and elevation in serum creatine kinase level among HIV-positive adults on combination antiretroviral therapy and treated with atorvastatin or rosuvastatin for at least 12 months between 2011 and 2015 in our outpatient unit.
A total of 545 patients (mean age 53.4 years) were enrolled into the study. Atorvastatin was prescribed in 55.8% of patients and rosuvastatin in 44.2%. After a mean duration of statin therapy of 29 months, an isolated symptomatic myalgia was diagnosed in 42 patients (7.7%) and a myalgia associated with elevated creatine kinase level in 25 (4.6%). The mean concentration of 25-hydroxyvitamin D was significantly lower in patients with myalgia (19.4 ng/ml) and with creatine kinase elevation and myalgia (22.8 ng/ml) than in those without muscle toxicity (32.1 ng/ml; P = 0.017 and 0.024, respectively). In stratified multivariable-adjusted logistic regression models, there was a statistically significant association between vitamin D deficiency and occurrence of symptomatic myalgia (P = 0.009) or creatine kinase elevation and myalgia (P = 0.046). Other factors significantly associated with development of myalgia were duration of statin therapy more than 24 months, history of myalgia, and age older than 60 years.
In our observational study, vitamin D deficiency was significantly associated with a statin-induced myalgia among HIV-infected patients on combination antiretroviral therapy, in conformity with data of the general population.
多项研究表明，在普通人群中，维生素D缺乏与他汀类药物相关症状性肌痛风险增加之间存在显著关联，但在HIV感染者中尚无相关数据。
开展一项回顾性队列研究，以评估2011年至2015年期间在我们门诊接受联合抗逆转录病毒治疗且使用阿托伐他汀或瑞舒伐他汀治疗至少12个月的HIV阳性成年人中症状性肌痛的发生率以及血清肌酸激酶水平的升高情况。
共有545例患者（平均年龄53.4岁）纳入研究。55.8%的患者使用阿托伐他汀，44.2%的患者使用瑞舒伐他汀。他汀类药物治疗的平均持续时间为29个月后，42例患者（7.7%）被诊断为单纯症状性肌痛，25例患者（4.6%）被诊断为与肌酸激酶水平升高相关的肌痛。有肌痛的患者（19.4纳克/毫升）以及肌酸激酶升高且有肌痛的患者（22.8纳克/毫升）的25-羟维生素D平均浓度显著低于无肌肉毒性的患者（32.1纳克/毫升；P分别为0.017和0.024）。在分层多变量调整逻辑回归模型中，维生素D缺乏与症状性肌痛的发生（P = 0.009）或肌酸激酶升高及肌痛之间存在统计学显著关联（P = 0.046）。与肌痛发生显著相关的其他因素包括他汀类药物治疗持续时间超过24个月、肌痛病史以及年龄大于60岁。
在我们的观察性研究中，与普通人群的数据一致，在接受联合抗逆转录病毒治疗的HIV感染患者中，维生素D缺乏与他汀类药物引起的肌痛显著相关。
