Use of HMG-CoA reductase inhibitors in the HIV population: implications for individualized treatment selection
| Autor: | Roberto V. Pichardo, Ashish Advani, Shreena Advani, Manish Patel, Yolanda Whitty |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Oncology
medicine.medical_specialty Atorvastatin Population Pharmaceutical Science Integrase inhibitor HIV Infections Pharmacy Pharmacology Zidovudine immune system diseases Internal medicine medicine Humans Rosuvastatin Drug Interactions Precision Medicine education education.field_of_study biology business.industry Health Policy nutritional and metabolic diseases virus diseases HIV Nelfinavir HMG-CoA reductase biology.protein Ritonavir Patient Care Hydroxymethylglutaryl-CoA Reductase Inhibitors business medicine.drug |
| Zdroj: | Journal of managed carespecialty pharmacy. 20(3) |
| ISSN: | 2376-1032 |
| Popis: | The World Health Organization reports that 34 million people are living with human immunodeficiency virus (HIV) worldwide. Several global organizations are making concerted efforts to treat and prevent HIV, centered around providing antiretroviral therapy (ART) to those who are infected and those at risk for infection. The first antiretroviral (ARV), zidovudine, was approved in 1987. Zidovudine belongs to the subclass known as nucleoside reverse transcriptase inhibitors (NRTIs). Since the advent of zidovudine, additional NRTIs and numerous other classes of ARVs have been introduced to the market, including nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors, fusion inhibitors, and coreceptor inhibitors. The use of these various classes in combination, known as highly active ART (HAART), provided yet another breakthrough in HIV treatment. In 2008, the Antiretroviral Therapy Cohort Collaboration collected data from several developed countries that showed increased life expectancy for those who began HAART at a CD4+ cell count > 200 per microliter of blood.2 Although HAART benefits people living with HIV, ARVs are not without significant risks. For instance, PIs, a key component of HAART, are associated with insulin resistance, lipodystrophy, dyslipidemia, and hepatoxicity. Notably, it has been estimated that the prevalence of hyperlipidemia in patients receiving PI-based ART may be close to 80%. The Department of Health and Human Services (DHHS) guidelines recommend the use of at least 3 ARVs in combination; of the 4 preferred regimens for nonpregnant, treatment-naive HIV patients, 2 contain PIs. Increased use of PIs and other ARVs, along with an increase in life expectancy, are suggested factors that explain a trend of increased hyperlipidemia diagnoses seen in the HIV-infected population. Statins are a class of medications used to block cholesterol production in the liver. While statins are generally deemed well tolerated, serious side effects such as lethal rhabdomyolysis can occur when concentrations are increased. Recently, a review of drug-drug interactions between statins and PIs, with an emphasis on metabolic pathways, was published. Of the 7 statins currently available (atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin), 3 (atorvastatin, lovastatin, and simvastatin) are metabolized through cytochrome P450 (CYP) 3A. All PIs except nelfinavir are coadministered with ritonavir, which is considered a potent COMMENTARY |
| Databáze: | OpenAIRE |
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