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Statins in HIV-Infected Patients: Potential Beneficial Effects and Clinical Use

Enrique Bernal¹, Irene Marín², Mar Masiá³

¹Infectious Disease Unit, Hospital General Universitario Reina Sofía, Murcia, Spain.

|February 10, 2017

Insights

Statins, used for cardiovascular disease prevention, show benefits beyond cholesterol reduction. Despite underutilization in HIV patients, this review supports their clinical use in this population.

Area of Science:

Cardiology
Infectious Diseases
Pharmacology

Background:

HIV infection increases cardiovascular disease (CVD) risk due to chronic inflammation, immune activation, and antiretroviral therapy side effects.
Statins are widely used in the general population for CVD mortality reduction and possess anti-inflammatory and cardioprotective properties.
Statins are underutilized in HIV-infected patients, likely due to safety concerns and limited outcome data.

Purpose of the Study:

To review clinical studies on statin use in HIV-infected patients.
To discuss statin side effects, interactions, and pleiotropic effects in this population.
To provide recommendations for clinical statin use in patients living with HIV.

Main Methods:

Review of clinical studies evaluating statins in HIV-infected patients.
Analysis of statin side effect and drug interaction profiles.
Discussion of anti-atherosclerotic and pleiotropic effects of statins.

Main Results:

Statins offer benefits beyond lipid-lowering, including anti-inflammatory and endothelial function improvements.
Despite safety concerns, available data suggest potential benefits for HIV patients.
Underutilization in HIV patients contrasts with their established role in the general population.

Conclusions:

Statins have demonstrated pleiotropic effects beneficial for cardiovascular health.
Further research and clinical guidance are needed to optimize statin use in HIV management.
Recommendations for safe and effective statin prescription in HIV-infected individuals are proposed.

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Abstract:

Patients living with HIV have an increased risk of cardiovascular disease that is considered to be the result of an interaction between traditional cardiovascular risk factors, particularly smoking and dyslipidemia, and persistent chronic inflammation and immune activation associated with HIV infection, along with side effects of antiretroviral therapy. In the general population, the administration of statins has been associated with a reduction in cardiovascular disease-associated mortality, and these drugs are among the most common class of medication prescribed in high-income countries. The beneficial effect of statins extends beyond reducing cholesterol levels as they have been shown to have anti- inflammatory, antithrombotic, antioxidant, immunomodulatory, and vasodilatory effects, and to improve endothelial function. Despite the widespread use of statins in the general population, cohort studies show that these drugs are underutilized in HIV-infected patients, probably due to safety concerns by clinicians and limited data evaluating clinical outcomes in patients on antiretroviral therapy. In this article we review and update the most important clinical studies of statins in HIV- infected patients, describe their side effects and interaction profiles, and discuss the anti-atherosclerotic and pleiotropic effects of these drugs. Finally, we propose recommendations for clinical use of statins in patients living with HIV.

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