Risk of acute liver injury after statin initiation by human immunodeficiency virus and chronic hepatitis c virus infection status

Dana D. Byrne, Janet P. Tate, Kimberly A. Forde, Joseph K. Lim, Matthew Bidwell Goetz, David Rimland, Maria C. Rodriguez-Barradas, Adeel A. Butt, Cynthia L. Gibert, Sheldon T. Brown, Roger Bedimo, Matthew S. Freiberg, Amy C. Justice, Jay R. Kostman, Jason A. Roy, Vincent Lo Re

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background. Patients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection May be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status. Methods. We conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17 739 HIV-monoinfected, and 36 604 uninfected persons in the Veterans Aging Cohort Study (2000–2012). We determined development of (1) liver aminotransferases >200 U/L, (2) severe ALI (coagulopathy with hyperbiliru-binemia), and (3) death, all within 18 months. Cox regression was used to determine propensity score–adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of outcomes in statin initiators compared to nonusers across the groups. Results. Among HIV/HCV-coinfected patients, statin initiators had lower risks of aminotransferase levels >200 U/L (HR, 0.66 [95% CI, .53–.83]), severe ALI (HR, 0.23 [95% CI, .12–.46]), and death (HR, 0.36 [95% CI, .28–.46]) compared with statin nonusers. In the setting of chronic HCV alone, statin initiators had reduced risks of aminotransferase elevations (HR, 0.57 [95% CI, .45–.72]), severe ALI (HR, 0.15 [95% CI, .06–.37]), and death (HR, 0.42 [95% CI, .32–.54]) than nonusers. Among HIV-monoinfected patients, statin initiators had lower risks of aminotransferase increases (HR, 0.52 [95% CI, .40–.66]), severe ALI (HR, 0.26 [95% CI, .13–.55]), and death (HR, 0.19 [95% CI, .16–.23]) compared with nonusers. Results were similar among uninfected persons. Conclusions. Regardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.

Original languageEnglish (US)
Pages (from-to)1542-1550
Number of pages9
JournalClinical Infectious Diseases
Volume65
Issue number9
DOIs
StatePublished - Nov 1 2017

Keywords

  • Acute liver injury
  • HIV
  • Hepatitis C
  • Hepatotoxicity
  • Statins

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Byrne, D. D., Tate, J. P., Forde, K. A., Lim, J. K., Goetz, M. B., Rimland, D., Rodriguez-Barradas, M. C., Butt, A. A., Gibert, C. L., Brown, S. T., Bedimo, R., Freiberg, M. S., Justice, A. C., Kostman, J. R., Roy, J. A., & Lo Re, V. (2017). Risk of acute liver injury after statin initiation by human immunodeficiency virus and chronic hepatitis c virus infection status. Clinical Infectious Diseases, 65(9), 1542-1550. https://doi.org/10.1093/cid/cix564