1. Risk of Acute Liver Injury After Statin Initiation by Human Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status.
- Author
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Byrne, Dana D, Tate, Janet P, Forde, Kimberly A, Lim, Joseph K, Goetz, Matthew Bidwell, Rimland, David, Rodriguez-Barradas, Maria C, Butt, Adeel A, Gibert, Cynthia L, Brown, Sheldon T, Bedimo, Roger, Freiberg, Matthew S, Justice, Amy C, Kostman, Jay R, Roy, Jason A, and Lo Re, Vincent
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Emerging Infectious Diseases ,Rare Diseases ,Genetics ,Hepatitis - C ,Infectious Diseases ,Hepatitis ,Clinical Research ,Liver Disease ,Chronic Liver Disease and Cirrhosis ,Digestive Diseases ,HIV/AIDS ,Infection ,Good Health and Well Being ,Chemical and Drug Induced Liver Injury ,Female ,HIV Infections ,Hepatitis C ,Chronic ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Incidence ,Male ,Middle Aged ,Retrospective Studies ,Risk Factors ,statins ,HIV ,hepatitis C ,hepatotoxicity ,acute liver injury ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundPatients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection may be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status.MethodsWe conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17739 HIV-monoinfected, and 36604 uninfected persons in the Veterans Aging Cohort Study (2000-2012). We determined development of (1) liver aminotransferases >200 U/L, (2) severe ALI (coagulopathy with hyperbilirubinemia), and (3) death, all within 18 months. Cox regression was used to determine propensity score-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of outcomes in statin initiators compared to nonusers across the groups.ResultsAmong HIV/HCV-coinfected patients, statin initiators had lower risks of aminotransferase levels >200 U/L (HR, 0.66 [95% CI, .53-.83]), severe ALI (HR, 0.23 [95% CI, .12-.46]), and death (HR, 0.36 [95% CI, .28-.46]) compared with statin nonusers. In the setting of chronic HCV alone, statin initiators had reduced risks of aminotransferase elevations (HR, 0.57 [95% CI, .45-.72]), severe ALI (HR, 0.15 [95% CI, .06-.37]), and death (HR, 0.42 [95% CI, .32-.54]) than nonusers. Among HIV-monoinfected patients, statin initiators had lower risks of aminotransferase increases (HR, 0.52 [95% CI, .40-.66]), severe ALI (HR, 0.26 [95% CI, .13-.55]), and death (HR, 0.19 [95% CI, .16-.23]) compared with nonusers. Results were similar among uninfected persons.ConclusionsRegardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.
- Published
- 2017