Real-life management of drug-drug interactions between antiretrovirals and statins. Journal of Antimicrobial Chemotherapy
Courlet et al. aimed to assess the management of drug–drug interactions (DDIs) between antiretrovirals (ARVs) and statins in people living with HIV (PLWH) of the Swiss HIV Cohort Study (SHCS) considering statin plasma concentrations, compliance with dosing recommendations and achievement of lipid targets. Individual non-HDL and triglyceride (TC) target values were set using the Framingham score and the 2018 European AIDS Clinical Society recommendations.
Data were analysed for rosuvastatin (n= 99), atorvastatin (n= 92), pravastatin (n= 46) and pitavastatin (n= 21). Rosuvastatin and atorvastatin underdosing frequently led to suboptimal pharmakodynamic response. Insufficient lipid control was observed with protease inhibitors (PIs) despite high atorvastatin concentrations, likely explained by inhibition of OATP1B1 resulting in less statin uptake in the liver. Target lipid values were more often achieved with unboosted integrase inhibitors due to both their favourable DDI profiles and neutral effect on lipids. Insufficient lipid control was common with pravastatin and pitavastatin regardless of co-administered ARVs and despite using maximal recommended statin doses. The latter suggests lower efficacy compared with rosuvastatin or atorvastatin.
In conclusion, suboptimal management of dyslipidaemia is common in PLWH due to statin underdosing or the use of low-intensity statins leading overall to 41% of statin prescriptions with suboptimal response. Management of dyslipidaemia in patients on PIs is challenging due to DDIs and their negative impact on lipidprofile, potentially impairing the therapeutic effect of statins. Unboosted integrase strand transfer inhibitors or rilpivirine-based regimens and/or treatment with rosuvastatin or atorvastatin should be favoured in patients with re-fractory dyslipidaemia.