Safety and Efficacy of HMG‐CoA Reductase Inhibitors for Treatment of Hyperlipidemia in Patients with HIV Infection

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Abstract
Study Objective. To assess the efficacy and safety of HMG‐CoA reductase inhibitors (statins) in patients with human immunodeficiency virus (HIV) infection and hyperlipidemia. Design. Retrospective analysis. Setting. HIV clinic. Patients. Twenty‐six HIV‐infected patients with hyperlipidemia. Intervention. Five patients received pravastatin, 13 lovastatin, 10 simvastatin, and 2 atorvastatin (total 30 courses). Measurements and Main Results. Reductions in cholesterol and triglycerides were used to assess efficacy; creatine kinase (CK), liver enzymes, and myalgia were markers of statin toxicity. After a median of 8.2 and 7.2 months of treatment, the agents collectively reduced median baseline total cholesterol 27% (354 to 263 mg/dl) and triglycerides 15% (513 to 438 mg/dl), respectively. Two patients, one with marked CK elevations, experienced myalgias with lovastatin, and two experienced transaminase elevations 3 or more times the upper limit of normal. Conclusion. Statins are effective in reducing total cholesterol and triglycerides in HIV‐infected patients, although lipid levels infrequently return to normal. Lovastatin should be avoided in patients receiving concomitant drugs that may potentiate skeletal muscle toxicity with this agent.