HIV 感染和慢性丙型肝炎病毒感染状态与他汀类药物起始后急性肝损伤的风险。
Risk of Acute Liver Injury After Statin Initiation by Human Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status.
机构信息
Departments of Medicine, Penn Center for AIDS Research.
Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
出版信息
Clin Infect Dis. 2017 Oct 16;65(9):1542-1550. doi: 10.1093/cid/cix564.
BACKGROUND
Patients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection may be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status.
METHODS
We conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17739 HIV-monoinfected, and 36604 uninfected persons in the Veterans Aging Cohort Study (2000-2012). We determined development of (1) liver aminotransferases >200 U/L, (2) severe ALI (coagulopathy with hyperbilirubinemia), and (3) death, all within 18 months. Cox regression was used to determine propensity score-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of outcomes in statin initiators compared to nonusers across the groups.
RESULTS
Among HIV/HCV-coinfected patients, statin initiators had lower risks of aminotransferase levels >200 U/L (HR, 0.66 [95% CI, .53-.83]), severe ALI (HR, 0.23 [95% CI, .12-.46]), and death (HR, 0.36 [95% CI, .28-.46]) compared with statin nonusers. In the setting of chronic HCV alone, statin initiators had reduced risks of aminotransferase elevations (HR, 0.57 [95% CI, .45-.72]), severe ALI (HR, 0.15 [95% CI, .06-.37]), and death (HR, 0.42 [95% CI, .32-.54]) than nonusers. Among HIV-monoinfected patients, statin initiators had lower risks of aminotransferase increases (HR, 0.52 [95% CI, .40-.66]), severe ALI (HR, 0.26 [95% CI, .13-.55]), and death (HR, 0.19 [95% CI, .16-.23]) compared with nonusers. Results were similar among uninfected persons.
CONCLUSIONS
Regardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.
背景
患有人类免疫缺陷病毒（HIV）和/或慢性丙型肝炎病毒（HCV）感染的患者可能会被开具他汀类药物作为治疗代谢/心血管疾病的药物，但目前尚不清楚与非使用者相比，HIV/HCV 状态分类组中的他汀类药物起始使用者发生急性肝损伤（ALI）的风险是否增加。
方法
我们进行了一项队列研究，比较了在退伍军人老龄化队列研究（2000-2012 年）中 7686 例 HIV/HCV 合并感染、8155 例 HCV 单感染、17739 例 HIV 单感染和 36604 例未感染人群中，他汀类药物起始使用者与非使用者的 ALI 发生率。我们确定了（1）肝转氨酶 >200 U/L，（2）严重 ALI（伴有高胆红素血症的凝血功能障碍）和（3）死亡，所有这些均在 18 个月内发生。使用 Cox 回归确定了在各组中与非使用者相比，他汀类药物起始使用者的结局的倾向评分调整后的风险比（HR）及其 95%置信区间（CI）。
结果
在 HIV/HCV 合并感染患者中，与他汀类药物非使用者相比，他汀类药物起始使用者的转氨酶水平 >200 U/L（HR，0.66 [95%CI，0.53-0.83]）、严重 ALI（HR，0.23 [95%CI，0.12-0.46]）和死亡（HR，0.36 [95%CI，0.28-0.46]）的风险较低。在单独慢性 HCV 的情况下，与非使用者相比，他汀类药物起始使用者的转氨酶升高（HR，0.57 [95%CI，0.45-0.72]）、严重 ALI（HR，0.15 [95%CI，0.06-0.37]）和死亡（HR，0.42 [95%CI，0.32-0.54]）的风险降低。在 HIV 单感染患者中，与非使用者相比，他汀类药物起始使用者的转氨酶升高（HR，0.52 [95%CI，0.40-0.66]）、严重 ALI（HR，0.26 [95%CI，0.13-0.55]）和死亡（HR，0.19 [95%CI，0.16-0.23]）的风险较低。在未感染者中，结果相似。
结论
无论 HIV 和/或慢性 HCV 状态如何，与非使用者相比，他汀类药物起始使用者在 18 个月内发生 ALI 和死亡的风险较低。
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