Chastain Daniel B, Stover Kayla R, Riche Daniel M
University of Georgia College of Pharmacy, Albany, GA, USA.
Phoebe Putney Memorial Hospital, Department of Pharmacy, Albany, GA, USA.
J Clin Transl Endocrinol. 2017 Feb 22;8:6-14. doi: 10.1016/j.jcte.2017.01.004. eCollection 2017 Jun.
As a result of improved safe and effective therapeutic options for human immunodeficiency virus (HIV), life expectancy of those living with HIV is increasing leading to new challenges (e.g., management of chronic diseases). Some chronic diseases (e.g., cardiovascular disease [CVD]), are up to two times more prevalent in patients with HIV. Statins are a mainstay of therapy for prevention of CVD; but, clinicians should be aware that not all statins are appropriate for use in the HIV population, especially those receiving antiretroviral therapy (ART). The purpose of this article is to review the pharmacokinetic and clinical data for statin therapy in HIV-infected patients receiving ART.
A systematic literature search using PubMed and MEDLINE databases was performed using each statin drug name combined with HIV, pharmacokinetics, AIDS, and/or human immunodeficiency virus. English language trials published from 1946 to November 2016 were considered, and results were limited to clinical efficacy trials.
In general, atorvastatin and pravastatin are safe and effective for patients treated with protease-inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor-based ART. Rosuvastatin is generally considered safe if started at a low dose, but should be avoided if possible in patients receiving PI-based ART. Pitavastatin has limited supporting evidence, but appears safe for use based on its pharmacokinetic properties and low number of drug interactions. Fluvastatin, lovastatin, and simvastatin should be avoided in patients receiving ART due to drug interactions, adverse events, and/or limited clinical data.
Clinicians need to be familiar with the intricacies of statin selection for the prevention of CVD in patients with HIV on ART.
由于人类免疫缺陷病毒（HIV）的安全有效治疗方案有所改进，HIV感染者的预期寿命正在增加，这带来了新的挑战（例如，慢性病管理）。一些慢性病（如心血管疾病[CVD]）在HIV患者中的患病率高达两倍。他汀类药物是预防CVD的主要治疗药物；但是，临床医生应意识到并非所有他汀类药物都适用于HIV人群，尤其是那些接受抗逆转录病毒疗法（ART）的患者。本文的目的是回顾接受ART的HIV感染患者使用他汀类药物治疗的药代动力学和临床数据。
使用PubMed和MEDLINE数据库进行系统文献检索，检索词为每种他汀类药物名称与HIV、药代动力学、艾滋病和/或人类免疫缺陷病毒的组合。纳入1946年至2016年11月发表的英文试验，结果仅限于临床疗效试验。
一般来说，阿托伐他汀和普伐他汀对接受基于蛋白酶抑制剂（PI）或非核苷类逆转录酶抑制剂的ART治疗的患者是安全有效的。瑞舒伐他汀如果低剂量起始通常被认为是安全的，但在接受基于PI的ART治疗的患者中应尽可能避免使用。匹伐他汀的支持证据有限，但基于其药代动力学特性和较少的药物相互作用，似乎使用安全。由于药物相互作用、不良事件和/或有限的临床数据，接受ART治疗的患者应避免使用氟伐他汀、洛伐他汀和辛伐他汀。
临床医生需要熟悉为接受ART治疗的HIV患者预防CVD选择他汀类药物的复杂性。
