Effect of statin therapy in reducing the risk of serious non-AIDS-defining events and nonaccidental death.

TitleEffect of statin therapy in reducing the risk of serious non-AIDS-defining events and nonaccidental death.
Publication TypeJournal Article
Year of Publication2013
AuthorsOverton ET, Kitch D, Benson CA, Hunt PW, Stein JH, Smurzynski M, Ribaudo HJ, Tebas P
JournalClin Infect Dis
Volume56
Issue10
Pagination1471-9
Date Published2013 May
ISSN1537-6591
KeywordsAdult, Cardiovascular Diseases, Cohort Studies, Diabetes Complications, Female, HIV Infections, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Inflammation, Longitudinal Studies, Male, Middle Aged, Neoplasms, Proportional Hazards Models, Randomized Controlled Trials as Topic
Abstract

BACKGROUND: Excessive inflammation persists despite antiretroviral treatment. Statins decrease cardiovascular (CV) disease risk by reducing low-density lipoprotein cholesterol and inflammation. We performed an exploratory analysis to evaluate whether statin therapy decreased risk of non-AIDS-defining events and nonaccidental death.

METHODS: A total of 3601 subjects not on a statin from the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort were included. Outcome was time to first clinical event (CV event, renal or hepatic disease, incident diabetes, thrombotic/embolic event, nontraumatic fracture, non-AIDS-defining malignancy, serious bacterial infection, or nonaccidental death); event categories were also analyzed separately. Inverse probability of treatment and censoring weighted Cox proportional hazard models were used to assess the causal statin effect. Differential statin effects by baseline covariates were evaluated.

RESULTS: Over 15 135 person-years (PY) of follow-up, 484 subjects initiated statins; 616 experienced an event (crude event rate, 4.4/100 PY on a statin and 4.1/100 PY not on a statin); the unadjusted hazard ratio (HR) was 1.17 (95% confidence interval [CI], .91-1.50). In a final weighted model, the adjusted HR (AHR) was 0.81 (95% CI, .53- 1.24). Results for other clinical events were similar, except for malignancies (AHR, 0.43 [95% CI, .19-.94]) and bacterial infections (AHR, 1.30 [95% CI, .64-2.65]). No differential statin effects by baseline covariates were detected.

CONCLUSIONS: Although statin therapy was not associated with a reduction in time to all non-AIDS-defining event or nonaccidental death, it was associated with a statistically significant 57% reduction in non-AIDS-defining malignancies. Confirmatory studies are needed to evaluate statin-associated reduction in risk of cancer and non-AIDS-associated morbidities.

DOI10.1093/cid/cit053
Alternate JournalClin. Infect. Dis.
PubMed ID23386631
PubMed Central IDPMC3693493
Grant ListP30 AI027767 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069496 / AI / NIAID NIH HHS / United States