title: Is Impact of Statin Therapy on All-Cause Mortality Different in HIV-Infected Individuals Compared to General Population? Results from the FHDH-ANRS CO4 Cohort.
abstract: BACKGROUND
  The effect of statins on all-cause mortality in the general population has been estimated as 0.86 (95%CI 0.79-0.94) for primary prevention. Reported values in HIV-infected individuals have been discordant. We assessed the impact of statin-based primary prevention on all-cause mortality among HIV-infected individuals.
  
  
  METHODS
  Patients were selected among controls from a multicentre nested case-control study on the risk of myocardial infarction. Patients with prior cardiovascular or cerebrovascular disorders were not eligible. Potential confounders, including variables that were associated either with statin use and/or death occurrence and statin use were evaluated within the last 3 months prior to inclusion in the case-control study. Using an intention to continue approach, multiple imputation of missing data, Cox's proportional hazard models or propensity based weighting, the impact of statins on the 7-year all-cause mortality was evaluated.
  
  
  RESULTS
  Among 1,776 HIV-infected individuals, 138 (8%) were statins users. During a median follow-up of 53 months, 76 deaths occurred, including 6 in statin users. Statin users had more cardiovascular risk factors and a lower CD4 T cell nadir than statin non-users. In univariable analysis, the death rate was higher in statins users (11% vs 7%, HR 1.22, 95%CI 0.53-2.82). The confounders accounted for were age, HIV transmission group, current CD4 T cell count, haemoglobin level, body mass index, smoking status, anti-HCV antibodies positivity, HBs antigen positivity, diabetes and hypertension. In the Cox multivariable model the estimated hazard ratio of statin on all-cause mortality was estimated as 0.86 (95%CI 0.34-2.19) and it was 0.83 (95%CI 0.51-1.35) using inverse probability treatment weights.
  
  
  CONCLUSIONS
  The impact of statin for primary prevention appears similar in HIV-infected individuals and in the general population.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lang
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Lacombe
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France.
authors.forename: Murielle
authors.initials: M
authors.lastname: Mary-Krause
authors.affiliation: Hôpitaux Universitaires de Strasbourg, Le Trait D'Union, centre de soins de l'infection par le VIH, Strasbourg, France.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Partisani
authors.affiliation: APHP, Hôpital Avicenne, service de maladie infectieuse, Bobigny, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bidegain
authors.affiliation: Hospices Civils de Lyon, Hôpital de la Croix Rousse, service des maladies infectieuses et tropicales, Lyon, France; INSERM U1052, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Cotte
authors.affiliation: APHP, Hôtel Dieu, service de médecine interne, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Aslangul
authors.affiliation: APHP, Hôtel Necker, laboratoire de virologie, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, EA 3620, Paris, France; Centre hospitalier de Tourcoing, service des maladies infectieuses, Tourcoing, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Chéret
authors.affiliation: APHP, Hôpital Saint-Antoine, service de cardiologie, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM (UMRS 938), F75012, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Boccara
authors.affiliation: APHP, Hôpital Saint-Antoine, service des maladies infectieuses et tropicales, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Meynard
authors.affiliation: Centre hospitalier universitaire de Nice, groupe hospitalier l'Archet, service de santé publique, Nice, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.affiliation: Centre hospitalier universitaire de Nice, groupe hospitalier l'Archet, service d'infectiologie, Nice, France; Université de Nice, Sophia-Antipolis, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roger
authors.affiliation: Hôpital Universitaire Pontchaillou, service des maladies infectieuses et USI, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: APHP, Hôpital Saint-Louis, service des maladies infectieuses et tropicales, Paris, France; Université de Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM (U941), Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors