Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice

Fehmida Visnegarwala, Mario Maldonado, Prasuna Sajja, Jennifer L. Minihan, Maria C. Rodriguez-Barradas, Oliver Ong, Christopher J. Lahart, Mirza Qasim Hasan, Ashok Balasubramanyam, A. Clinton White

Research output: Contribution to journalArticle

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Abstract

Objectives. Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting. Methods. Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks. Results. An overall mean reduction of 16% in total cholesterol, 20% non-HDL cholesterol, and 18% in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7)% with fibrates, -11 (-14)% with statins and -23 (-22)% for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40)% in those treated with fibrates; -1 (-21)% in those with statins alone, and -32 (-42)% in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95% CI: 2.1-48.9; p <0.005). Conclusion. In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalJournal of Infection
Volume49
Issue number4
DOIs
StatePublished - Nov 2004
Externally publishedYes

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Fibric Acids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Dyslipidemias
Cholesterol
HIV
Lipids
Triglycerides
Therapeutics
Ritonavir
Drug Evaluation
Protease Inhibitors
Pharmaceutical Preparations
Primary Health Care
Logistic Models
Regression Analysis
Guidelines
Education

Keywords

  • Antiretroviral therapy
  • Cohort study
  • HIV dyslipidemia
  • Lipid lowering drugs

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice. / Visnegarwala, Fehmida; Maldonado, Mario; Sajja, Prasuna; Minihan, Jennifer L.; Rodriguez-Barradas, Maria C.; Ong, Oliver; Lahart, Christopher J.; Hasan, Mirza Qasim; Balasubramanyam, Ashok; White, A. Clinton.

In: Journal of Infection, Vol. 49, No. 4, 11.2004, p. 283-290.

Research output: Contribution to journalArticle

Visnegarwala, F, Maldonado, M, Sajja, P, Minihan, JL, Rodriguez-Barradas, MC, Ong, O, Lahart, CJ, Hasan, MQ, Balasubramanyam, A & White, AC 2004, 'Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice', Journal of Infection, vol. 49, no. 4, pp. 283-290. https://doi.org/10.1016/j.jinf.2003.09.006
Visnegarwala, Fehmida ; Maldonado, Mario ; Sajja, Prasuna ; Minihan, Jennifer L. ; Rodriguez-Barradas, Maria C. ; Ong, Oliver ; Lahart, Christopher J. ; Hasan, Mirza Qasim ; Balasubramanyam, Ashok ; White, A. Clinton. / Lipid lowering effects of statins and fibrates in the management of HIV dyslipidemias associated with antiretroviral therapy in HIV clinical practice. In: Journal of Infection. 2004 ; Vol. 49, No. 4. pp. 283-290.
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abstract = "Objectives. Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting. Methods. Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks. Results. An overall mean reduction of 16{\%} in total cholesterol, 20{\%} non-HDL cholesterol, and 18{\%} in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7){\%} with fibrates, -11 (-14){\%} with statins and -23 (-22){\%} for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40){\%} in those treated with fibrates; -1 (-21){\%} in those with statins alone, and -32 (-42){\%} in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95{\%} CI: 2.1-48.9; p <0.005). Conclusion. In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.",
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AU - Visnegarwala, Fehmida

AU - Maldonado, Mario

AU - Sajja, Prasuna

AU - Minihan, Jennifer L.

AU - Rodriguez-Barradas, Maria C.

AU - Ong, Oliver

AU - Lahart, Christopher J.

AU - Hasan, Mirza Qasim

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AU - White, A. Clinton

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N2 - Objectives. Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting. Methods. Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks. Results. An overall mean reduction of 16% in total cholesterol, 20% non-HDL cholesterol, and 18% in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7)% with fibrates, -11 (-14)% with statins and -23 (-22)% for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40)% in those treated with fibrates; -1 (-21)% in those with statins alone, and -32 (-42)% in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95% CI: 2.1-48.9; p <0.005). Conclusion. In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.

AB - Objectives. Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting. Methods. Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks. Results. An overall mean reduction of 16% in total cholesterol, 20% non-HDL cholesterol, and 18% in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7)% with fibrates, -11 (-14)% with statins and -23 (-22)% for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40)% in those treated with fibrates; -1 (-21)% in those with statins alone, and -32 (-42)% in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95% CI: 2.1-48.9; p <0.005). Conclusion. In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.

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