期刊
CLINICAL INFECTIOUS DISEASES
卷 52, 期 3, 页码 387-395出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciq111
关键词
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资金
- National Institute of (NIAID) at the National Institutes of Health [AI-60464, AI-27757]
- American Heart Association [09050129G]
- Center for AIDS Research at the National Institutes of Health Network of Integrated Clinical Systems [R24 AI067039]
- Achillion Pharmaceuticals
- Ardea
- Avexa
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Gilead
- GlaxoSmithKline
- Merck
- Monogram Biosciences
- Panacos
- Pain Therapeutics
- Pfizer
- Progenics
- Roche
- Serono
- Tanox
- Tibotec Therapeutics
- Trimeris
- Vertex
- Definicare
- Astra Zeneca
Background. Dyslipidemia is common and is often treated with 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins). Little is known about the comparative effectiveness of statins among human immunodeficiency virus (HIV)-infected patients. This study compared the effectiveness and toxicity of statins among HIV-infected patients in clinical care. Methods. We conducted a retrospective cohort study of patients starting their initial statin medications at 2 large HIV clinics (N = 700). The primary observation was change in lipid levels during statin therapy. Secondary observations included whether individualized National Cholesterol Education Program (NCEP) goals for low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) levels were reached, and toxicity rates. We used linear regression to examine change in lipid levels, controlling for baseline lipid values and demographic and clinical characteristics. We conducted secondary analyses using propensity scores to address confounding by indication. Results. The most commonly prescribed statins were atorvastatin (N = 303), pravastatin (N = 280), and rosuvastatin (N = 95). One year after starting a statin therapy, patients who received atorvastatin or rosuvastatin had significantly greater decreases in total cholesterol, LDL-C, and non-HDL-C than patients on pravastatin. The likelihood of reaching NCEP goals for LDL-C levels was higher with the use of rosuvastatin (OR 2.1; P = .03) and atorvastatin (odds ratio [OR], 2.1; P = .001) compared with that of pravastatin. The likelihood of reaching NCEP goals for non-HDL-C levels was higher for rosuvastatin (OR 2.3; P = .045) but not atorvastatin (OR, 1.5; P = .1) compared with pravastatin. Toxicity rates were similar for all 3 statins: 7.3% for atorvastatin, 6.1% for pravastatin, and 5.3% for rosuvastatin. Conclusions. Our findings suggest that atorvastatin and rosuvastatin are preferable to pravastatin for treatment of HIV-infected patients with dyslipidemia, due to greater declines in total cholesterol, LDL-C, and non-HDL-C, with similar lower toxicity rates.
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