Is Impact of Statin Therapy on All-Cause Mortality Different in HIV-Infected Individuals Compared to General Population? Results from the FHDH-ANRS CO4 Cohort

• Published in: PloS one Vol. 10; no. 7; p. e0133358
• Main Authors: Lang, Sylvie, Lacombe, Jean-Marc, Mary-Krause, Murielle, Partisani, Marialuisa, Bidegain, Frédéric, Cotte, Laurent, Aslangul, Elisabeth, Chéret, Antoine, Boccara, Franck, Meynard, Jean-Luc, Pradier, Christian, Roger, Pierre-Marie, Tattevin, Pierre, Costagliola, Dominique, Molina, Jean-Michel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.07.2015; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Analysis; Antibodies; Body mass; Body mass index; Body size; Cardiac patients; Cardiovascular agents; Cardiovascular diseases; CD4 antigen; Cerebrovascular diseases; Diabetes mellitus; Disease transmission; Female; Follow-Up Studies; France - epidemiology; Health aspects; Health risk assessment; Health risks; Hemoglobin; Hepatitis C virus; HIV; HIV Infections - blood; HIV Infections - drug therapy; HIV Infections - mortality; HIV patients; Human health and pathology; Human immunodeficiency virus; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hypertension; Life Sciences; Lymphocytes T; Male; Middle Aged; Missing data; Mortality; Motivation; Myocardial infarction; Patients; Prevention; Risk analysis; Risk factors; Risk management; Smoking; Statins; T cells; Time Factors; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0133358

The effect of statins on all-cause mortality in the general population has been estimated as 0.86 (95%CI 0.79-0.94) for primary prevention. Reported values in HIV-infected individuals have been discordant. We assessed the impact of statin-based primary prevention on all-cause mortality among HIV-infected individuals. Patients were selected among controls from a multicentre nested case-control study on the risk of myocardial infarction. Patients with prior cardiovascular or cerebrovascular disorders were not eligible. Potential confounders, including variables that were associated either with statin use and/or death occurrence and statin use were evaluated within the last 3 months prior to inclusion in the case-control study. Using an intention to continue approach, multiple imputation of missing data, Cox's proportional hazard models or propensity based weighting, the impact of statins on the 7-year all-cause mortality was evaluated. Among 1,776 HIV-infected individuals, 138 (8%) were statins users. During a median follow-up of 53 months, 76 deaths occurred, including 6 in statin users. Statin users had more cardiovascular risk factors and a lower CD4 T cell nadir than statin non-users. In univariable analysis, the death rate was higher in statins users (11% vs 7%, HR 1.22, 95%CI 0.53-2.82). The confounders accounted for were age, HIV transmission group, current CD4 T cell count, haemoglobin level, body mass index, smoking status, anti-HCV antibodies positivity, HBs antigen positivity, diabetes and hypertension. In the Cox multivariable model the estimated hazard ratio of statin on all-cause mortality was estimated as 0.86 (95%CI 0.34-2.19) and it was 0.83 (95%CI 0.51-1.35) using inverse probability treatment weights. The impact of statin for primary prevention appears similar in HIV-infected individuals and in the general population.