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  ICAAC 2015 55th Interscience Conference
on Antimicrobial Agents and Chemotherapy
September 5-9, 2015, San Diego, CA
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Pitavastatin Lowers Inflammation/Activation Markers in HIV+ Over 52 Weeks
  ICAAC 2016, June 16-20, 2016, Boston
ASM: Effects of Pitavastatin on Markers of Arterial Inflammation and Immune Activation in HIV Patients - (06/24/16)
Mark Mascolini
Pitavastatin lowered LDL cholesterol and markers of systemic activation and arterial inflammation significantly more than pravastatin in a 52-week randomized, placebo-controlled trial involving 234 adults with HIV infection [1]. Massachusetts General Hospital and Mount Sinai School of Medicine researchers believe their findings "suggest that pitavastatin may be an ideal statin to optimally improve lipids and inflammatory markers in HIV-infected patients."
Some of the same investigators previously reported that pitavastatin cut dangerous LDL cholesterol more than pravastatin through 52 weeks [2]. This new report adds analyses of inflammation and activation markers.
The trial enrolled adults with a viral load below 200 copies while taking an antiretroviral combination (excluding darunavir) for more than 6 months. Everyone had a CD4 count above 200 for more than 3 months. No one had a history of coronary heart disease, active systemic infection, or secondary dyslipidemia. At randomization participants had LDL cholesterol between 130 and 220 mg/dL and triglycerides at or below 400 mg/dL. The researchers randomized them to 4 mg of pitavastatin daily (plus pravastatin placebo) or 40 mg of pravastatin daily (plus pitavastatin placebo).
The analysis included 117 people taking pitavastatin and 117 taking pravastatin. Median age stood at 50 years in both treatment groups, and the groups did not differ in gender (about 87% men), race (about 82% white), body mass index (about 27 kg/m2), or LDL cholesterol (about 153 mg/dL).
At week 52 LDL cholesterol had dropped 31% with pitavastatin versus 21% with pravastatin, a significant difference (P = 0.0007). At the same point the pitavastatin group also had significantly better changes in the following markers:
-- sCD14 (activation marker): -8.2% versus +0.6% (P = 0.007)
-- Lp-PLA2 (inflammation marker): -25% versus -14.9% (P = 0.003)
-- oxLDL (inflammation marker): -26.6% versus -17.6% (P = 0.02)
Although pravastatin is often prescribed for people with HIV, the researchers concluded, pitavastatin appears to do a better job lowering LDL cholesterol and improving markers of arterial inflammation and immune activation. They called for further studies to determine whether these differences affect cardiovascular event rates in people with HIV.
1. Fitch K, Zanni M, Burdo T, et al. Effects of pitavastatin on markers of arterial inflammation and immune activation in HIV patients. ICAAC 2016, June 16-20, 2016, Boston. Abstract Monday-249.
2. Sponseller CA, Aberg J, INTREPID Team. After 52 weeks pitavastatin is superior to pravastatin for LDL-C lowering in patients with HIV. Conference on Retroviruses and Opportunistic Infections, March 3-6, 2014, Boston. Abstract 751LB. http://www.croiconference.org/sites/default/files/posters/751LB.pdf