AT CROI 2017

SEATTLE (FRONTLINE MEDICAL NEWS) – Statins appeared to reduce the risk of viral rebound in HIV patients on antiretroviral therapy, suggesting modest antiviral activity, according to a review of 19,324 HIV-positive veterans who started combination ART from 1995-2011.

It’s been shown before that statins are active against HIV in vitro; the new study is likely the first to show an effect in actual patients, and it was only found in those who used statins consistently, perhaps because of the drugs’ short half-life. “In addition to their cardiovascular benefits, statins could increase the durability of successful antiretroviral therapy. Whether this effect is direct or mediated by [statins’] anti-inflammatory properties merits further evaluation,” concluded investigators led by Henning Drechsler, MD, an infectious disease specialist at the Dallas Veterans Affairs Medical Center.

Viral loads were undetectable after the subjects started ART; 55% had viral failure (VF) after a median of 15 months, defined as a viral load of more than 1,000 copies/mL on one blood test, or two consecutive viral loads above 200 copies/mL.

After adjusting for a range of confounders, including demographics, substance use, and ART adherence assessed by pharmacy fill records, the team found that statins use within 7 days of testing was associated with almost a 20% drop in the risk of decreased risk of VF (adjusted HR 0.81, 95% 0.75-0.88), with a similar benefit for use within 3 months. There was no protective effect for blood pressure drugs, and a slight increase for patients on cardioprotective aspirin.

About a third of the patients – almost all men, around 48 years old – had at least tried statins, generally after their viral loads were suppressed and most often pravastatin or simvastatin. Statins’ protection against VF was present over the whole study period and among all types of ART and levels, but became less pronounced after 2005 in patients with optimal ART adherence, and in those taking newer options. The median observation time was 5.9 years.

“I am very confident that this is not a data fluke,” Dr. Drechsler said at the 2017 Conference on Retroviruses and Opportunistic Infections. He noted that there may even be role for statin use in HIV patients without dyslipidemia, but with the current study, “it’s hard to say. You really do need a prospect study.”

He plans to keep looking into the issue. Meanwhile, a large trial of statin use in HIV is underway.

Dr. Drechsler said he had no disclosures.

aotto@frontlinemedcom.com

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