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Safety and Efficacy of Simvastatin for the Treatment of Dyslipidemia in Human Immunodeficiency Virus‐Infected Patients Receiving Efavirenz‐Based Highly Active Antiretroviral Therapy
Author(s) -
Rahman Anita P.,
Eaton Susan A.,
Nguyen Sean T.,
Bain Amy M.,
Payne Kenna D.,
Bedimo Roger,
Busti Anthony J.
Publication year - 2008
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.28.7.913
Subject(s) - efavirenz , simvastatin , dyslipidemia , medicine , regimen , viral load , adverse effect , immunology , human immunodeficiency virus (hiv) , antiretroviral therapy , obesity
Study Objectives. To evaluate the safety and efficacy of simvastatin for treatment of dyslipidemia in patients with the human immunodeficiency virus (HIV) who were receiving efavirenz‐based highly active antiretroviral therapy (HAART), and to evaluate the effect of simvastatin when added to efavirenz on CD4 + count, HIV viral load, and frequency of attainment of patient‐specific National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III lipid goals. Design. Retrospective medical record review. Setting. Veterans Affairs health care system in Dallas, Texas. Patients. Thirteen HIV‐infected men who received a stable efavirenz‐based HAART regimen concurrently with simvastatin 20 mg/day, and 19 HIV‐negative men who received simvastatin 20 mg/day (controls). Measurements and Main Results. Demographic, clinical, and laboratory data were collected before and after starting simvastatin. Reductions in lipid profile values in the HIV‐infected group versus HIV‐negative group were as follows: total cholesterol −20% versus −28% (p=0.15), low‐density lipoprotein cholesterol (LDL) −36% versus −41% (p=0.06), non‐high‐density lipoprotein cholesterol (non‐HDL) −22% versus −33% (p=0.212), and total cholesterol:HDL ratio −33% versus −30% (p=0.26). These effects were seen without any documented adverse drug reactions or changes in viral and immunologic control. However, 28% fewer HIV‐infected patients were able to achieve NCEP ATP III LDL goals compared with HIV‐negative subjects. Conclusion. These preliminary comparative data suggest that simvastatin can be safely and effectively used to treat dyslipidemia in HIV‐infected patients receiving efavirenz‐based HAART without compromising viral or immunologic control. However, our results are suggestive of slight lessening of the LDL‐lowering effects, which might be explained by the known reduction in simvastatin levels with efavirenz. Furthermore, fewer HIV‐infected patients were able to meet their NCEP ATP III goals compared with HIV‐negative controls, highlighting the difficulty in treating this population to current standards of care.