title: Rosuvastatin Worsens Insulin Resistance in HIV-Infected Adults on Antiretroviral Therapy.
abstract: BACKGROUND
  Statins are associated with increased diabetes risk in large, human immunodeficiency virus (HIV)-uninfected cohorts; the impact of statins on insulin resistance or diabetes in HIV-infected persons has not been assessed within a randomized controlled study.
  
  
  METHODS
  HIV-infected participants on stable antiretroviral therapy with a low-density lipoprotein cholesterol level of ≤130 mg/dL and heightened immune activation or inflammation were randomized to rosuvastatin 10 mg daily or placebo for 96 weeks. Fasting serum glucose, insulin, and hemoglobin A1C (HgbA1C) were measured; insulin resistance was estimated by calculating the homeostatic model assessment of insulin resistance (HOMA-IR); and a 2-hour oral glucose tolerance test was administered.
  
  
  RESULTS
  Seventy-two participants were randomized to rosuvastatin therapy and 75 to placebo. Increases in fasting glucose were observed within both groups but were not different between study arms (P = .115); changes in glucose tolerance and HgbA1C did not differ between study arms (P = .920 and P = .650, respectively). Criteria for diabetes were met by 1 participant in the rosuvastatin and 3 in the placebo arm by week 96. Compared with placebo, rosuvastatin therapy was associated with significantly greater increases in insulin and HOMA-IR (P = .008 and P = .004, respectively).
  
  
  CONCLUSIONS
  We detected a significant worsening in insulin resistance and an increase in the proportion of participants with impaired fasting glucose but not a clinical diagnosis of diabetes in the rosuvastatin arm. Our findings suggest that prescription of statin therapy should be accompanied by a careful consideration of the risks and benefits, particularly in patients with lower cardiovascular disease risk.
  
  
  BACKGROUND
  NCT01218802.
authors.affiliation: Department of Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado, Aurora.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
authors.affiliation: Department of Epidemiology and Biostatistics.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology and Biostatistics.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Debanne
authors.affiliation: Department of Medicine and Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Grace A
authors.initials: GA
authors.lastname: McComsey
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D000068718:Rosuvastatin Calcium / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D044966:Anti-Retroviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010919:Placebos; D000068718:Rosuvastatin Calcium
keywords: HOMA-IR; glucose metabolism; inflammation; insulin resistance; statin