Table 4.

Statins to highly active antiretroviral therapy-associated dyslipidemia

Drug	Metabolism and interactions
Simvastatin	Considerable CYP3A4 metabolism. ↑ simvastatin levels with PIs and ↓↓ levels with efavirenz. Not recommended with atazanavir, atazanavir/ritonavir, fosamprenavir/ritonavir, saquinavir/ritonavir, tipranavir/ritonavir, lopinavir/ritonavir, indinavir/ritonavir, darunavir/ritonavir and nelfinavir. Doses of 80 mg/d with NNRTIs, raltegravir and selzentry
Lovastatin	Not recommended with atazanavir, atazanavir/ritonavir, fosamprenavir/ritonavir, saquinavir/ritonavir, tipranavir/ritonavir, lopinavir/ritonavir, indinavir/ritonavir, darunavir/ritonavir and nelfinavir. Doses of 80 mg/d with NNRTIs, raltegravir and selzentry
Atorvastatin	Somewhat CYP3A4 metabolism, ↑ levels with PIs darunavir, lopinavir, saquinavir/ritonavir, fosamprenavir. ↓levels with efavirenz. Doses of 20 mg/d with PIs, 80 mg/d with NNRTIs, raltegravir and selzentry
Pravastatin	Reduced interaction with CYP450 metabolism, primarily renal excretion but 50% ↓ with lopinavir/ritonavir, 45% ↓with nelfinavir, 80% ↑with darunavir/ritonavir, and 40% ↓ with efavirenz. Doses of 80 mg/d with PIs, NNRTIs, raltegravir and selzentry
Fluvastatin	Metabolized by CYP2C9, and occasional interactions with nelfinavir and efavirenz. Doses of 80 mg/d with PIs, NNRTIs, raltegravir and selzentry
Rosuvastatin	Not CYP3A4 metabolized but 5 × ↑ levels with lopinavir/ritonavir and darunavir/ritonavir (uncertain). Low starting doses (5-10 mg) recommended with PIs. Doses of 20 mg/d with PIs, 40 mg/d with NNRTIs, raltegravir and selzentry

NNRTIs: Non-nucleoside reverse transcriptase inhibitors.