Is Statin Therapy Safe in Patients with Hiv/Hepatitis C Coinfection?(Clinical Report‪)‬

In the United States, as of 2003, approximately 1.2 million people were living with HIV or AIDS (1). HIV, the virus that causes AIDS, is a retrovirus that can be spread through exposure to blood, semen, or vaginal fluid. Hepatitis C virus (HCV) is a single-strand RNA that infects liver cells. Currently, HCV infection is the leading cause of death due to liver disease in the US (2). HCV is transmitted primarily through blood exposure. In the US, approximately 3.2 million people are chronically infected with HCV (3). HIV and HCV coinfection is becoming more prevalent. In fact, worldwide, approximately 20% to 25% of all HIV-infected patients also have HCV infection (4). In the US, data published in 2002 estimate this coinfection rate at 16.1% (5). This is a concern because coinfected patients progress to cirrhosis faster that those with HCV infection alone (4, 6). It is also a concern because coinfection may complicate the delivery of effective HIV treatments in the setting of active liver disease (7). Cholesterol-lowering drugs such as the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have become a valuable tool to manage patients with cardiovascular disease because of their ability to decrease low-density lipoprotein (LDL) cholesterol, stabilize plaque, decrease inflammatory markers, and decrease mortality in patients with and without established vascular disease (8). In patients with HIV infection, dyslipidemia is prevalent due to the effects of highly active antiretroviral therapies (HAART) that may be utilized (9). In HIV patients, treatment of LDL is complicated by the interactions of statins with HAART, and some studies have shown that atorvastatin and pravastatin may be used with ritonavir and saquinavir, but that simvastatin should be avoided (10). Recent data have also been published that support the safety and efficacy of rosuvastatin and fluvastatin in patients with HIV infection on HAART therapy (11, 12). Statins have also been shown to have activity against HCV (2, 13-15). In fact, some statins appear to have greater anti-HCV activity than others (14).