TY - JOUR
T1 - Lipid-lowering therapy in HIV-infected patients
T2 - Relationship with antiretroviral agents and impact of substance-related disorders
AU - Bednasz, Cindy
AU - Luque, Amneris E.
AU - Zingman, Barry S.
AU - Fischl, Margaret A.
AU - Gripshover, Barbara M.
AU - Venuto, Charles S.
AU - Gu, Jie
AU - Feng, Zekun
AU - DiFrancesco, Robin
AU - Morse, Gene D.
AU - Ma, Qing
N1 - Funding Information:
The contributions of Raju Sadal, Julie Sarlo, Carol Greisberger, Leslie Thompson, Norma Storer and the clinical research staff at the Montefiore Medical Center AIDS Center, the University of Rochester HIV Program, the University of Miami AIDS Research Unit, and the University Hospitals Case Medical Center HIV Program and the patients at each of the participating HIV treatment centers is appreciated. The dedication of the research staff of the UB Pharmacotherapy Research Center, Core Analytical Laboratory is also appreciated. The study was supported by R01DA015024 from the National Institute on Drug Abuse. Dr Zingman was supported in part by the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI51519). Dr Ma was supported in part by the Clinical Scientist Research Career Development Award from the National Institute of Mental Health (K08MH098794).
Publisher Copyright:
© 2016 Bentham Science Publishers.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background: The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome. Materials and Methods: The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipidlowering agent use. Results: A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for subjects with SRD (25 vs 8%, p=0.02). Conclusion: Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.
AB - Background: The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome. Materials and Methods: The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipidlowering agent use. Results: A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for subjects with SRD (25 vs 8%, p=0.02). Conclusion: Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.
KW - Dyslipidemia
KW - Fibrates
KW - HIV
KW - Lipid-lowering therapy
KW - Metabolic disorder
KW - Statins
KW - Substance-related disorders
UR - http://www.scopus.com/inward/record.url?scp=84964004953&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84964004953&partnerID=8YFLogxK
U2 - 10.2174/1570161114666160106151652
DO - 10.2174/1570161114666160106151652
M3 - Article
C2 - 26733388
AN - SCOPUS:84964004953
SN - 1570-1611
VL - 14
SP - 280
EP - 287
JO - Current Vascular Pharmacology
JF - Current Vascular Pharmacology
IS - 3
ER -