Rosuvastatin should be considered for HIV-positive people with dyslipidemia — and guidelines should be updated to reflect that, suggests a new study.

Although guidelines from the Infectious Diseases Society of America and the Adult AIDS Clinical Trials Group recommend pravastatin or atorvastatin for these individuals, authors of the current study, published in Clinical Infectious Diseases, found that patients who were prescribed rosuvastatin or atorvastatin had better improvement in their cholesterol levels than patients given pravastatin.

The study “raises the question of whether it’s time for the IDSA guidelines to be updated for patients with HIV,” Dr. Heidi Crane, one of the study’s authors from the Harborview Medical Center and the University of Washington, told Reuters Health. Doctors, she added, “are probably overusing pravastatin.”

The authors followed 700 adults who were treated for dyslipidemia at two HIV clinics over a median of 19 months. Of those patients, 43% were prescribed atorvastatin, 40% pravastatin, and 14% rosuvastatin.

After 12 months of treatment, the total cholesterol of patients on pravastatin dropped an average of 25 mg/dL, compared to 43 mg/dL in patients on rosuvastatin (p = 0.004 compared to pravastatin) and 39 mg/dL in patients on atorvastatin (p < 0.001 compared to pravastatin.) LDL-C and Non-HDL-C levels both decreased significantly more in patients on rosuvastatin and patients on atorvastatin compared to those prescribed pravastatin. Of all patients who received their initial statin for 12 months and for whom the authors had complete data, 71% met National Cholesterol Education Program goals for LDL-C levels and 62% met goals for non-HDL-C levels after a year of treatment. Patients prescribed rosuvastatin (OR = 2.1; p = 0.03) and those on atorvastatin (OR = 2.1; p = 0.001) had higher odds than those on pravastatin of reaching NCEP goals for LDL-C levels after a year, and patients on rosuvastatin had higher odds of reaching non-HDL-C goals than those receiving pravastatin over the same time period (OR = 2.3; p = 0.045). Toxicity occurred in 6.4% of cases and was similar for patients on each drug. The most common potentially serious toxicity was an elevation in creatine phosphokinase (CPK) levels. Dr. Crane said that while some European guidelines have been updated to include rosuvastatin for HIV-positive patients, U.S. recommendations were written before it became a common drug. With rosuvastatin showing success in the non-HIV population, Dr. Crane said that despite its absence from the guidelines, doctors caring for patients with HIV have begun incorporating it into treatment. “We’re sort of following along” with the literature, she said. “And it’s time to follow quicker.” Dr. Kristine Scordo, who heads the Acute Care Nurse Practitioner Program at Wright State University-Miami Valley College of Nursing and Health and was not involved in the research, said that the positive results in patients taking rosuvastatin are consistent with what she sees in clinical practice. “Everybody knows that rosuvastatin is one of the most powerful drugs out there. What’s in this article is a known fact,” she told Reuters Health. “The guidelines need to be updated because rosuvastatin is a great drug. We all use it, but you won’t find it in the guidelines.” Because many patients in the study did not reach NCEP goals, the authors also question whether combination lipid-lowering treatment may be necessary for patients with HIV. However, the low toxicity rates shown from all three drugs are a good sign for statin therapy in this group in general, Dr. Crane said. “I think that the recommendations from this are: statins are safer than we may have thought, so rethink whether patients with elevated lipids should be treated with them,” she said. But, “for many of these patients, they’re not going to make their targets on pravastatin, and so there should be some reconsideration of the type of statins used.” Reference:
Comparative Effectiveness and Toxicity of Statins Among HIV-Infected Patients

Clin Infect Dis, online 28 Dec 2010.