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. 2017 Oct 16;65(9):1542-1550.
doi: 10.1093/cid/cix564.

Risk of Acute Liver Injury After Statin Initiation by Human Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status

Dana D Byrne  1   2   3 , Janet P Tate  4   5 , Kimberly A Forde  1   2 , Joseph K Lim  4   5 , Matthew Bidwell Goetz  6 , David Rimland  7 , Maria C Rodriguez-Barradas  8 , Adeel A Butt  9   10   11 , Cynthia L Gibert  12 , Sheldon T Brown  13 , Roger Bedimo  14   15 , Matthew S Freiberg  16 , Amy C Justice  4   5 , Jay R Kostman  17 , Jason A Roy  2 , Vincent Lo Re 3rd  1   2
Affiliations

Risk of Acute Liver Injury After Statin Initiation by Human Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status

Dana D Byrne et al. Clin Infect Dis. .

Abstract

Background: Patients 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.

Methods: We 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.

Results: Among 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.

Conclusions: Regardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.

Keywords: HIV; acute liver injury; hepatitis C; hepatotoxicity; statins.

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Figures

Figure 1.
Figure 1.
Selection of patients for inclusion in the study. Abbreviations: ALI, acute liver injury; ALT, alanine aminotransferase; AST, aspartate aminotransferase; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus infection; HIV, human immunodeficiency virus; VACS, Veterans Aging Cohort Study.
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