Table 2.
Summary of the effect of different statins and other lipid-lowering medications
| Lipid-lowering medication | Main recommendation | References |
|---|---|---|
| Simvastatin and lovastatin | The HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trial Group recommended that simvastatin and lovastatin should not be given to patients taking PIs or delavirdine. This was also endorsed by the International AIDS Society USA Panel, which recommended that concomitant use of lovastatin or simvastatin with protease inhibitors or HAART is contraindicated. | 74–80 |
| Atorvastatin | The HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trial Group and International AIDS Society USA panel advised that atorvastatin is recommended as a first-line agent for high LDL-C, with a starting dose of atorvastatin 10 mg once daily. Caution is needed when combined with fenofibrate. In certain conditions, administration of atorvastatin (with clarithromycin and lopinavir/ritonavir, delavirdine) was associated with rhabdomyolysis. | 15,17,81 |
| Pravastatin | Pravastatin is recommended as first line in the management of HIV dyslipidemia. Interestingly, the combination therapy with fenofibrate and pravastatin for HIV-related dyslipidemia provides substantial improvements in lipid parameters and appears safe. The International AIDS Society USA panel recommended pravastatin and atorvastatin as first-line agents. | 82–85 |
| Rosuvastatin | Rosuvastatin is not metabolized by CYP3A4 and is eliminated through feces. Interestingly, rosuvastatin 10 mg/day was more effective than pravastatin 40 mg/day on LDL-C and triglyceride levels in HIV-1-infected patients receiving a boosted protease inhibitor. Interestingly, rosuvastatin and atorvastatin are preferable to pravastatin, due to greater declines in total cholesterol, LDL-C, and non-HDL-C. | 86–91 |
| Fluvastatin | The recommendations of the HIV Association of the Infectious Disease Society of America and Adult AIDS Clinical Trials Group, were that fluvastatin was a reasonable alternative to atorvastatin and pravastatin for patients on protease inhibitors. | 78,92,93 |
| Ezetimibe | Ezetimibe as monotherapy is an effective and safe lipid-lowering medication in HIV dyslipidemia, and also can be used in those with poor response to statin. In addition, the combination of statin and ezetimibe is also effective and safe lipid lowering medication in HIV-dyslipidaemia. | 94–99 |
| Fenofibrate | Fenofibrate is a generally safe and useful agent for the treatment of mixed dyslipidemia and hypertriglyceridemia in people with HIV infection. The combination of pravastatin, fish oil, and niacin with fenofibrate appears to be safe and effective. | 85,100–107 |
| Niacin | In two studies, niacin was effective and safe in improving lipid profile in HIV patients. | 108–110 |
Abbreviations: PIs, protease inhibitors; HAART, highly active antiretroviral therapy; LDL-C, low-density lipid cholesterol; HIV, human immunodeficiency virus; CYP3A4, cytochrome P450 3A4; HDL-C, high-density lipid cholesterol; AIDS, acquired immunodeficiency syndrome.