title: Lipid-Lowering Therapy in HIV-Infected Patients: Relationship with Antiretroviral Agents and Impact of Substance-Related Disorders.
abstract: BACKGROUND
  The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome.
  
  
  METHODS
  The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipid-lowering agent use.
  
  
  RESULTS
  A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for subjects with SRD (25 vs 8%, p=0.02).
  
  
  CONCLUSIONS
  Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.
authors.forename: Cindy
authors.initials: C
authors.lastname: Bednasz
authors.forename: Amneris E
authors.initials: AE
authors.lastname: Luque
authors.forename: Barry S
authors.initials: BS
authors.lastname: Zingman
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fischl
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Gripshover
authors.forename: Charles S
authors.initials: CS
authors.lastname: Venuto
authors.forename: Jie
authors.initials: J
authors.lastname: Gu
authors.forename: Zekun
authors.initials: Z
authors.lastname: Feng
authors.forename: Robin
authors.initials: R
authors.lastname: DiFrancesco
authors.forename: Gene D
authors.initials: GD
authors.lastname: Morse
authors.affiliation: Translational Pharmacology Research Core Center of Excellence in Bioinformatics and Life Sciences Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences University at Buffalo, Buffalo, NY 14214, USA. qingma@buffalo.edu.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ma
mesh_terms: D000328:Adult; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000627:therapeutic use; D003521:Cyclopropanes; D050171:Dyslipidemias / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D015228:Hypertriglyceridemia / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids; D008060:Lipodystrophy / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications* / Q000378:metabolism*
chemical_list: D000480:Alkynes; D044966:Anti-Retroviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids; C098320:efavirenz