Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Among virologically suppressed persons with HIV at moderate risk of cardiovascular disease, daily administration of rosuvastatin did not lead to significant reductions in inflammatory markers.

Evidence Rating Level: 1 (Excellent)

Due to immune dysregulation and chronic inflammation, people with HIV (PWH) have a high burden of cardiovascular disease (CVD) even with optimal antiretroviral therapy. Indeed, elevated IL-6 and hsCRP levels are associated with an increased risk of cardiovascular events. Statins – exerting a myriad of effects on lipids and inflammation – have been shown to be effective at reducing the risk of cardiovascular events and all-cause mortality among individuals at high risk of CVD. As such, this randomized, placebo-controlled trial of rosuvastatin explored whether virologically suppressed PWH would benefit from therapy at a lower CVD risk than currently recommended, in this instance those at moderate risk. 20 mg of rosuvastatin were administered daily to the 33 patients in the intervention cohort (median age = 54 years, 97.0% male) for 48 weeks, while 36 patients received a placebo (median age = 55 years, 100% male). Though administration of rosuvastatin was found to significantly decrease LDL, LDL/HDL, and total cholesterol levels when compared with placebo, serum levels of inflammatory markers, including IL-6, sTNFR-II, CXCL10, sVCAM-1, and sCD14, were not found to be significantly different. Among the intervention cohort, however, there was found to be small but significant increases in the proportion of intermediate (+1.3%, p = 0.02) and non-classical (+1.2%, p = 0.049) monocytes, with a resulting decrease in the proportion of classical monocytes (-3.3%, p = 0.003). In all, this study showed that PWH at moderate risk of CVD do not benefit from statin therapy to target reductions in chronic inflammation. Though the sample size was small and homogeneous, this study adds to the discussion surrounding statin use in PWH.

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