One of the largest studies to date to assess the safety and usefulness of cholesterol-lowering drugs in HIV-infected people shows that the drugs produce clinically meaningful improvements but that these drugs may not be quite as effective in this group as they are in HIV-uninfected individuals.But the study authors, led by Dr Michael J Silverberg, emphasized that the difference in efficacy among HIV-infected subjects was small, particularly for LDL cholesterol, and may in some cases be overcome by adjusting doses of cholesterol medications or changing the HIV-treatment regimen.
However, reductions in triglyceride levels were substantially greater in the non-HIV-infected group for the population as a whole, a difference of 15%. But the stuides noted that patients whose HIV was being treated with a non-nucleoside reverse transcriptase inhibitor (NNRTI), instead of a PI or combination therapy, and who were taking gemfibrozil for their cholesterol experienced reductions in triglycerides that were no different from the reductions seen in non-HIV-infected subjects.
"We're not saying that everyone who has high triglycerides, who is HIV positive, needs to be on NNRTIs, because treating their HIV disease really needs to take priority," Silverberg commented. "But if it's possible to have patients on an NNRTI, then that's a good therapeutic approach to have them on an NNRTI and treat with the fibrate, because then they are likely to have responses to treatment that are identical to the HIV- patient.
Elevated cholesterol and associated heart problems are known side effects of HIV medications, most notably protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NNRTI) , but may also be related to other metabolic factors or even the virus itself. As such, whether standard lipid-lowering drugs produce the same benefits in HIV-infected people as they do in the general population remains unclear.
The study is published in the March 3, 2009 issue of the Annals of Internal Medicine.
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