Pitavastatin – a new statin in HIV infection?


252 HIV positive patients on antiretroviral therapy with dyslipidemia were randomized to once daily treatment with either pitavastatin 4 mg daily or pravastatin 40 mg. The study was double dummy double blind. Both statins have favorable pharmacokinetic profiles in combination with antiretroviral therapy. However, pravastatin has an interaction with darunavir not seen with pitavastatin. Pitavastatin is mainly metabolized by glucuronidation. The effects of the two statins on markers of immune activation and arterial inflammation were compared. 99 patients in the pitavastatin group and 91 in the pravastatin group completed the trial. After 52 weeks there was a significantly greater reduction of inflammatory markers with pitavastatin compared to pravastatin. Soluble CD14, oxidized LDL and lipoprotein associated phospholipase 2 were all significantly lower in the pitavastatin arm. Neither drug had any impact on the levels of sCD163 and hsIL6 which are also markers of immune activation. There was no effect on fasting glucose, insulin or glycosylated hemoglobin.

Toribo et al. AIDS 2017;31:797-806

Comment: Will the increased reduction of inflammatory markers seen with pitavastatin translate into decreased morbidity and mortality in cardiovascular diseases in the HIV positive population? To demonstrate such an effect large scale clinical endpoint trials are required.