title: Significant association between statin-associated myalgia and vitamin D deficiency among treated HIV-infected patients.
abstract: Several studies have shown a significant association between vitamin D deficiency and an increased risk of statin-related symptomatic myalgia in the general population, but there are no data among HIV-infected persons.
  
  
  
  A retrospective, cohort study was conducted to assess the incidence of symptomatic myalgia and elevation in serum creatine kinase level among HIV-positive adults on combination antiretroviral therapy and treated with atorvastatin or rosuvastatin for at least 12 months between 2011 and 2015 in our outpatient unit.
  
  
  
  A total of 545 patients (mean age 53.4 years) were enrolled into the study. Atorvastatin was prescribed in 55.8% of patients and rosuvastatin in 44.2%. After a mean duration of statin therapy of 29 months, an isolated symptomatic myalgia was diagnosed in 42 patients (7.7%) and a myalgia associated with elevated creatine kinase level in 25 (4.6%). The mean concentration of 25-hydroxyvitamin D was significantly lower in patients with myalgia (19.4 ng/ml) and with creatine kinase elevation and myalgia (22.8 ng/ml) than in those without muscle toxicity (32.1 ng/ml; P = 0.017 and 0.024, respectively). In stratified multivariable-adjusted logistic regression models, there was a statistically significant association between vitamin D deficiency and occurrence of symptomatic myalgia (P = 0.009) or creatine kinase elevation and myalgia (P = 0.046). Other factors significantly associated with development of myalgia were duration of statin therapy more than 24 months, history of myalgia, and age older than 60 years.
  
  
  
  In our observational study, vitamin D deficiency was significantly associated with a statin-induced myalgia among HIV-infected patients on combination antiretroviral therapy, in conformity with data of the general population.
authors.affiliation: aUnit of Infectious Diseases, Department of Medical and Surgical Sciences bUnit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calza
authors.forename: Eleonora
authors.initials: E
authors.lastname: Magistrelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Colangeli
authors.forename: Marco
authors.initials: M
authors.lastname: Borderi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Contadini
authors.forename: Isabella
authors.initials: I
authors.lastname: Bon
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Re
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000069059:Atorvastatin / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D063806:Myalgia / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium / Q000008:administration & dosage / Q000009:adverse effects; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D044966:Anti-Retroviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin