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Background

Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nationwide cohort of HIV-infected individuals to estimate the impact of statin use on mortality before and after a diagnosis of cardiovascular disease, chronic kidney disease or diabetes.

Methods

We identified all Danish HIV-infected individuals 1,738 who initiated HAART after 1 January 1998, and achieved virological suppression within 180 days. Date of first redemption of a prescription of statin was obtained from the Danish National Prescription Registry. We used Poisson regression analysis to assess adjusted mortality rate ratios aMRR. First, time was censored at date of virological failure VL >500 copies-ml. Second, time was not censored at virological failure. All analyses were adjusted for potential confounders.

Results

In the analyses confined to observation time without virological failure + censoring statin therapy was associated with a non-statistically significant reduced rate of death aMRR 0.75; 95% CI: 0.33–1.68. No difference was observed in the analysis with no censoring aMRR 1.17; 95% CI: 0.66–2.07. Use of statin seemed to reduce mortality in individuals after a diagnosis of comorbidity {+ censoring: aMRR: 0.34; 95% CI: 0.11–1.04, −censoring: aMRR: 0.64; 95% CI: 0.32–1.29}. No difference in rate of death could be detected before first date of diagnosis of comorbidity {+ censoring: aMRR: 1.12; 95% CI: 0.34–3.62, −censoring: aMRR: 0.90; 95% CI: 0.28–2.88}.

Conclusion

Statin therapy might reduce all-cause mortality in HIV-infected individuals, but the impact on individuals with no comorbidity seems small or absent. An unambiguous proof of a causal relation can only be obtained in a randomized controlled trial, but the sample size predicted may be prohibitive for its conduct.



Autor: Line D. Rasmussen , Gitte Kronborg, Carsten S. Larsen, Court Pedersen, Jan Gerstoft, Niels Obel

Fuente: http://plos.srce.hr/



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