Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.

<h4>Introduction</h4>HIV infection is a disease associated with chronic inflammation and immune activation. Antiretroviral therapy reduces inflammation, but not to levels in comparable HIV-negative individuals. The HMG-coenzyme A reductase inhibitors (statins) inhibit several pro-inflamm...

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Autores principales:	Richard D Moore, John G Bartlett, Joel E Gallant
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fe742c71792c49bb87a7e85458071084
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spelling	oai:doaj.org-article:fe742c71792c49bb87a7e854580710842021-11-18T06:50:25ZAssociation between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.1932-620310.1371/journal.pone.0021843https://doaj.org/article/fe742c71792c49bb87a7e854580710842011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21765919/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>HIV infection is a disease associated with chronic inflammation and immune activation. Antiretroviral therapy reduces inflammation, but not to levels in comparable HIV-negative individuals. The HMG-coenzyme A reductase inhibitors (statins) inhibit several pro-inflammatory processes and suppress immune activation, and are a logical therapy to assess for a possible salutary effect on HIV disease progression and outcomes.<h4>Methods</h4>Eligible patients were patients enrolled in the Johns Hopkins HIV Clinical Cohort who achieved virologic suppression within 180 days of starting a new highly active antiretroviral therapy (HAART) regimen after January 1, 1998. Assessment was continued until death in patients who maintained a virologic suppression, with right-censoring of their follow-up time if they had an HIV RNA > 500 copies/ml. Cox proportional hazards regression was used to assess statin use as a time-varying covariate, as well as other demographic and clinical factors.<h4>Results</h4>A total of 1538 HIV-infected patients fulfilled eligibility criteria, of whom 238 (15.5%) received a statin while taking HAART. There were 85 deaths (7 in statin users, 78 in non-users). By multivariate Cox regression, statin use was associated with a relative hazard of 0.33 (95% CI: 0.14, 0.76; P = 0.009) after adjusting for CD4, HIV-1 RNA, hemoglobin and cholesterol levels at the start of HAART, age, race, HIV risk group, prior use of ART, year of HAART start, NNRTI vs. PI-based ART, prior AIDS-defining illness, and viral hepatitis coinfection. Malignancy, non-AIDS-defining infection and liver failure were particularly prominent causes of death.<h4>Discussion</h4>Statin use was associated with significantly lower hazard of dying in these HIV-infected patients who were being effectively treated with HAART as determined by virologic suppression. Our results suggest the need for confirmation in other observational cohorts, and if confirmed, the need for a clinical trial of statin use in HIV infection.Richard D MooreJohn G BartlettJoel E GallantPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 7, p e21843 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Richard D Moore John G Bartlett Joel E Gallant Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
description	<h4>Introduction</h4>HIV infection is a disease associated with chronic inflammation and immune activation. Antiretroviral therapy reduces inflammation, but not to levels in comparable HIV-negative individuals. The HMG-coenzyme A reductase inhibitors (statins) inhibit several pro-inflammatory processes and suppress immune activation, and are a logical therapy to assess for a possible salutary effect on HIV disease progression and outcomes.<h4>Methods</h4>Eligible patients were patients enrolled in the Johns Hopkins HIV Clinical Cohort who achieved virologic suppression within 180 days of starting a new highly active antiretroviral therapy (HAART) regimen after January 1, 1998. Assessment was continued until death in patients who maintained a virologic suppression, with right-censoring of their follow-up time if they had an HIV RNA > 500 copies/ml. Cox proportional hazards regression was used to assess statin use as a time-varying covariate, as well as other demographic and clinical factors.<h4>Results</h4>A total of 1538 HIV-infected patients fulfilled eligibility criteria, of whom 238 (15.5%) received a statin while taking HAART. There were 85 deaths (7 in statin users, 78 in non-users). By multivariate Cox regression, statin use was associated with a relative hazard of 0.33 (95% CI: 0.14, 0.76; P = 0.009) after adjusting for CD4, HIV-1 RNA, hemoglobin and cholesterol levels at the start of HAART, age, race, HIV risk group, prior use of ART, year of HAART start, NNRTI vs. PI-based ART, prior AIDS-defining illness, and viral hepatitis coinfection. Malignancy, non-AIDS-defining infection and liver failure were particularly prominent causes of death.<h4>Discussion</h4>Statin use was associated with significantly lower hazard of dying in these HIV-infected patients who were being effectively treated with HAART as determined by virologic suppression. Our results suggest the need for confirmation in other observational cohorts, and if confirmed, the need for a clinical trial of statin use in HIV infection.
format	article
author	Richard D Moore John G Bartlett Joel E Gallant
author_facet	Richard D Moore John G Bartlett Joel E Gallant
author_sort	Richard D Moore
title	Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
title_short	Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
title_full	Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
title_fullStr	Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
title_full_unstemmed	Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.
title_sort	association between use of hmg coa reductase inhibitors and mortality in hiv-infected patients.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/fe742c71792c49bb87a7e85458071084
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Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients.

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