December #108 : Moonlighting Statins - by David Gelman, MD

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Table of Contents

Detectable Rebels

Now See This

Editor's Letter-December 2004

Mailbox-December 2004

Down on the Pharma

Show and Tell

Pushing the Envelope

First, the Bad News

Milestones

Faster Forward

Prince Valiant

POS/NEG

Pregnant Pauses

Moonlighting Statins

They Soothe Tootsies, Don’t They?

Trouble in Mind

Pharm School

View from the Top



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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December 2004

Moonlighting Statins

by David Gelman, MD

Can cholesterol-lowering drugs reduce your viral load, too?

T he big-deal Journal of Experimental Medicine dropped a bombshell in August: Cholesterol-lowering statin meds may also reduce HIV viral load. Mevacor (lovastatin) inhibited HIV in a test tube, so Spanish researchers gave six HIVers (who’d never taken HAART ) 40 mg per day for one month. Viral loads fell in all six, though on average only by a factor of 4 (0.6 log)—most antivirals cause a drop of tenfold or more. “Absolutely fascinating,” says San Fran HIV doc Mary Romeyn, MD, who thinks the statins may do it indirectly by shrinking inflammation. The study poses promising questions:

Is the effect limited to Mevacor? The researchers think that any statin would lessen viral load.

Is the result durable? The monthlong study was too short to reveal whether HIV can mutate to escape the statins.

Why has this gone unnoticed until now—with so many HIVers taking statins? Only a larger trial will tell.

Have statins confounded earlier med studies? In many trials, participants take statins if HAART hikes their cholesterol. The HIV meds in the study would have been credited for any drop in these HIVers’ viral loads. (And HIV study pro Cal Cohen, MD, says he can’t recall any trial where data suggested a statin-induced viral-load decrease.)

Mevacor’s Merck and Lipitor’s Pfizer declined comment, but HIV docs let rip: “Not convincing,” says Keith Henry, MD, of the University of Minnesota, because the test-tube results were more dramatic than the human benefit. Cohen says he hasn’t seen signs of this effect in statin-taking patients. And Cornell’s Marshall Glesby, MD, warns, “There’s a potential for serious toxicity from interactions between certain statins and protease inhibitors.” As always, check with Doc before statin anything new.—



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