title: Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus-positive patients: a systematic review and meta-analysis.
abstract: The efficacy and safety of different statins for human immunodeficiency virus (HIV)-positive patients in the primary prevention setting remain to be established. In the present meta-analysis, 18 studies with 736 HIV-positive patients receiving combination antiretroviral therapy (cART) and treated with statins in the primary prevention setting were included (21.0% women, median age 44.1 years old). The primary endpoint was the effect of statin therapy on total cholesterol (TC) levels. Rosuvastatin 10 mg and atorvastatin 10 mg provided the largest reduction in TC levels [mean -1.67, 95% confidence interval (CI) (-1.99, -1.35) mmol/L; and mean -1.44, 95% CI (-1.85, -1.02) mmol/L, respectively]. Atorvastatin 80 mg and simvastatin 20 mg provided the largest reduction in low-density lipoprotein (LDL) [mean -2.10, 95% CI (-3.39, -0.81) mmol/L; and mean -1.57, 95% CI (-2.67, -0.47) mmol/L, respectively]. Pravastatin 10-20 mg [mean 0.24, 95% CI (0.10, 0.38) mmol/L] and atorvastatin 10 mg [mean 0.15, 95% CI (0.007, 0.23) mmol/L] had the largest increase in high-density lipoprotein, whereas atorvastatin 80 mg [mean -0.60, 95% CI (-1.09, -0.11) mmol/L] and simvastatin 20 mg [mean -0.61, 95% CI (-1.14, -0.08) mmol/L] had the largest reduction in triglycerides. The mean discontinuation rate was 0.12 per 100 person-years [95% CI (0.05, 0.20)], and was higher with atorvastatin 10 mg [26.5 per 100 person-years, 95% CI (-13.4, 64.7)]. Meta-regression revealed that nucleoside reverse transcriptase inhibitors-sparing regimens were associated with reduced efficacy for statin's ability to lower TC. Statin therapy significantly lowers plasma TC and LDL levels in HIV-positive patients and is associated with low rates of adverse events. Statins are effective and safe when dose-adjusted for drug-drug interactions with cART.
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy sebastiano.gili@gmail.com fabrizio.dascenzo@gmail.com.|Cardiogroup.org Collaborative Group, Italy.
authors: Sebastiano
authors: S
authors: Gili
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Walter
authors: W
authors: Grosso Marra
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy sebastiano.gili@gmail.com fabrizio.dascenzo@gmail.com.|Cardiogroup.org Collaborative Group, Italy.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Enrica
authors: E
authors: Lonni
authors: Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Andrea
authors: A
authors: Calcagno
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Margherita
authors: M
authors: Cannillo
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Flavia
authors: F
authors: Ballocca
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.|Cardiogroup.org Collaborative Group, Italy.
authors: Enrico
authors: E
authors: Cerrato
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Martina
authors: M
authors: Pianelli
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Umberto
authors: U
authors: Barbero
authors: Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy.
authors: Massimo
authors: M
authors: Mancone
authors: Department of Preventive Cardiology, St Luke's Hospital, Kansas City, MO, USA.
authors: James J
authors: JJ
authors: DiNicolantonio
authors: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA.
authors: Carl J
authors: CJ
authors: Lavie
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.|Cardiogroup.org Collaborative Group, Italy.
authors: Pierluigi
authors: P
authors: Omedè
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.|Cardiogroup.org Collaborative Group, Italy.
authors: Antonio
authors: A
authors: Montefusco
authors: Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Stefano
authors: S
authors: Bonora
authors: Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Turin, Italy.
authors: Mauro
authors: M
authors: Gasparini
authors: Cardiogroup.org Collaborative Group, Italy.|Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.|Cardiogroup.org Collaborative Group, Italy.
authors: Claudio
authors: C
authors: Moretti
authors: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents; D000069059:Atorvastatin; D008078:Cholesterol, LDL; D005260:Female; D015658:HIV Infections; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008297:Male; D011322:Primary Prevention; D011758:Pyrroles; D000068718:Rosuvastatin Calcium; D019821:Simvastatin
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin
keywords: Antiretroviral therapy; Cardiovascular risk; Dyslipidaemia; HIV-positive patients; Statin therapy