title: Comparative Effectiveness and Toxicity of Statins Among HIV-Infected Patients.
abstract: BACKGROUND
  dyslipidemia is common and is often treated with 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins). Little is known about the comparative effectiveness of statins among human immunodeficiency virus (HIV)-infected patients. This study compared the effectiveness and toxicity of statins among HIV-infected patients in clinical care.
  
  
  METHODS
  we conducted a retrospective cohort study of patients starting their initial statin medications at 2 large HIV clinics (N = 700). The primary observation was change in lipid levels during statin therapy. Secondary observations included whether individualized National Cholesterol Education Program (NCEP) goals for low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) levels were reached, and toxicity rates. We used linear regression to examine change in lipid levels, controlling for baseline lipid values and demographic and clinical characteristics. We conducted secondary analyses using propensity scores to address confounding by indication.
  
  
  RESULTS
  the most commonly prescribed statins were atorvastatin (N = 303), pravastatin (N = 280), and rosuvastatin (N = 95). One year after starting a statin therapy, patients who received atorvastatin or rosuvastatin had significantly greater decreases in total cholesterol, LDL-C, and non-HDL-C than patients on pravastatin. The likelihood of reaching NCEP goals for LDL-C levels was higher with the use of rosuvastatin (OR 2.1; P = .03) and atorvastatin (odds ratio [OR], 2.1; P = .001) compared with that of pravastatin. The likelihood of reaching NCEP goals for non-HDL-C levels was higher for rosuvastatin (OR 2.3; P = .045) but not atorvastatin (OR, 1.5; P = .1) compared with pravastatin. Toxicity rates were similar for all 3 statins: 7.3% for atorvastatin, 6.1% for pravastatin, and 5.3% for rosuvastatin.
  
  
  CONCLUSIONS
  our findings suggest that atorvastatin and rosuvastatin are preferable to pravastatin for treatment of HIV-infected patients with dyslipidemia, due to greater declines in total cholesterol, LDL-C, and non-HDL-C, with similar lower toxicity rates.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA 98104, USA.
authors.forename: Sudershan
authors.initials: S
authors.lastname: Singh
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
authors.forename: Robert H
authors.initials: RH
authors.lastname: Knopp
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Kosel
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D005464:Fluorobenzenes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006538:Heptanoic Acids / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium; D044967:Serum / Q000737:chemistry; D013449:Sulfonamides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002784:Cholesterol; D000069059:Atorvastatin