OAKLAND, Calif., March 2, 2009 – A new study in the online issue of Annals of Internal Medicine has found that cholesterol medications can work well among certain HIV patients at risk for cardiovascular disease.
Though HIV patients are at higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies, researchers now have evidence that cholesterol medications work very well in this population.
"This should be encouraging for patients and their providers," said the study's lead author Michael Silverberg, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research in Oakland. CA. He explained that HIV Patients getting cholesterol-lowering treatments such as statins get slightly less benefit on cholesterol levels from the treatment as patients without HIV infection, but it is still a clinically significant benefit and side effects from the drugs occurred in very few patients.
In addition, say the researchers, the use of fibrates in combination with NNRTIs (a class of antiretroviral drugs) may be a good choice to manage triglyceride levels in HIV patients. Triglycerides are another fat in that blood that contributes to inflammation of the pancreas and may contribute to coronary disease, they explain.
The study, which appears in the March 3, 2009 online issue of the Annals of Internal Medicine, is the largest to date to compare the effectiveness and side effects of drugs to treat cholesterol problems in patients with and without HIV infection.
"The good news is lipid lowering therapy in HIV patients works, not quite as well as it does in patients without HIV, but close," explained Silverberg. Given the challenges for treating high cholesterol in HIV patients and the more aggressive target lipid goals for all patients, optimizing lifestyle factors like obesity and hypertension are also important factors to monitor for those with HIV infection, he added.
Researchers studied 829 patients with HIV infection and 6941 patients without HIV infection in the Kaiser Permanente health system that started cholesterol treatment during 1996 to 2005. The researchers compared changes in levels of low-density lipoprotein (LDL) cholesterol (bad cholesterol) and triglycerides (another fat in the blood) after the start of cholesterol treatment in patients with and without HIV infection. They also looked at liver and muscle-related side effects of cholesterol treatments and whether the cholesterol changes in patient with HIV infection were related to the types of HIV treatments patients were taking. Among patients taking statins, LDL levels declined only 3% less for HIV patients; however, among patients taking gemfibrozil, triglyceride levels declined 15% less for HIV patients. HIV patients taking both NNRTIs and gemfibrozil had identical triglyceride declines compared with those without HIV infection. Side effects of cholesterol treatments occurred in very few patients, but patients with HIV infection did have more changes in liver and muscle enzyme levels than patients without HIV infection.
Additional researchers include Wendy Leyden, MPH, Leo Hurley, MPH, Alan S. Go, MD, Charles P. Quesenberry, Jr., PhD. Daniel Klein, MD, Michael Horberg, MD, MAS, all affiliated with Kaiser Permanente in Northern California. Funding for this study was provided by GlaxoSmithKline
About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/)
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.
About Kaiser Permanente Research
Kaiser Permanente's eight research centers comprise one of the largest research programs in the United States and engage in work designed to improve the health of individuals everywhere. KP HealthConnect™ , Kaiser Permanente's electronic health record, and other resources provide population data for research, and in turn, research findings are fed into KP HealthConnect™ to arm physicians with research and clinical data. Kaiser Permanente's research program works with national and local health agencies and community organizations to share and widely disseminate its research data. Kaiser Permanente's research program is funded in part by Kaiser Permanente's Community Benefit division, which in 2007 directed an estimated $1 billion in health services, technology, and funding toward total community health.
About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded in 1945, the program is headquartered in Oakland, Calif. Kaiser Permanente serves 8.6 million members in nine states and the District of Columbia. Today it encompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 164,000 technical, administrative and clerical employees and caregivers, and 14,000 physicians representing all specialties. The organization's Labor Management Partnership is the largest such health care partnership in the United States. It governs how more than 130,000 workers, managers, physicians and dentists work together to make Kaiser Permanente the best place to receive care, and the best place to work. For more Kaiser Permanente news, visit the Kaiser Permanente News Center at: http://xnet.kp.org/newscenter
Journal
Annals of Internal Medicine