USE OF LIPID-LOWERING DRUGS BY PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

Elizabeth Phillips^1,2, Ahmed M Bayoumi^1,2, Janet M Raboud^3,4, Peggy Millson³, Gregory Robinson, Anita Rachlis^1,3
1Sunnybrook and Womens’ College Health Sciences Centre; ²Ontario HIV Treatment Network; ³University of Toronto; ⁴Mount Sinai Hospital

Objective: Hyperlipidemia has been noted with highly active antiretroviral therapy (HAART) and may be particularly associated with protease inhibitor (PI)-based regimens. We described the use of lipid-lowering therapy among individuals using HAART.
Methods: We analyzed participants enrolled in the HIV Ontario Observational Database (HOOD), a longitudinal voluntary cohort study. Trained chart abstracters recorded medication use from patient records. We defined HAART as a regimen consisting of 3 or more antiretrovirals and differentiated between those including (PI-HAART) or excluding (nonPI-HAART) protease inhibitors.
Results: Of 1541 individuals in the database, 227 (15%) had ever used lipid-lowering therapy. The most commonly used lipid-lowering drugs were fenofibrate (46% of prescriptions), atorvastatin (28%), and pravastatin (17%); 16% of patients using lipid-lowering drug used more than one simultaneously and 23% used more than one drug sequentially. We evaluated 10,042 individual drug regimens of which 51% were HAART and 86% of HAART regimens contained protease inhibitors. When lipid-lowering drugs were prescribed, 84% of antiretroviral regimens were HAART. Use of lipid-lowering therapy was more common with PI-HAART than with nonPI-HAART regimens (8.2 vs. 6.0%, p=0.037). Individuals using more than one protease inhibitor had a particularly high rate of use of lipid-lowering therapy (14%, p<0.001 compared to those using 1 PI). The median time from initiation of the first HAART regimen to initiation of a lipid-lowering drug was shorter for PI-HAART than for nonPI-HAART regimens (median 2.7 vs. 3.4 years, p=0.03). Only 15% of patients discontinued lipid-lowering therapy; of these, 12% changed from a PI-HAART to a nonPI-HAART regimen.
Conclusions: Lipid-lowering therapy use is common and is associated with protease inhibitor use. Regimens that do not include protease inhibitors may decrease pill burden, avoid potential drug interactions, and be less costly compared to PI-based HAART regimens.