HIV/HCV coinfected patients are at high risk for HCV disease progression compared to those without HIV. HMG-coenzyme A reductase inhibitors (statins) have anti-HCV activity in vitro and suppress immune activation in vivo. To test the hypothesis that statins may delay HCV progression, we examined the relationship of statins and liver disease progression in coinfected persons.
Coinfected patients in the Johns Hopkins HIV Cohort (Baltimore, MD) were prospectively observed from 1/1/2001 to 12/31/2014. Data on demographics, medications, clinical outcomes and laboratory tests were collected. The primary outcome was liver disease progression assessed by change in the FIB-4 score, defined as a confirmed increase of ≥ 1 category. The FIB-4 score was categorized as: < 1.45 no/mild fibrosis (F0/1); 1.45 to 3.25, moderate fibrosis (F2/3); > 3.25 cirrhosis (F4). Progression was assessed in non-cirrhotic patients. The incidence rates of progression were estimated and Cox proportional hazards regression was used to assess the relationship of progression and statins.
1366 HIV/HCV coinfected patients were prospectively observed; 230 patients (16.8%) used statins (median use, 1.47 years). Compared to non-users, statin users were older (median age, 48 > 44 years), were more likely to have diabetes (36% > 17%) and on antiretrovirals (55% > 46%). Cirrhosis was similar in statin users (18%) and non-users (15%). Death was more common in non-users (28%) compared to users (13%, P< .0001). Among 1041 patients without cirrhosis, liver disease progression occurred in 48% and 7% of statin non-users and users, respectively (P< .0001) and the incidence rate per 1000 person-years was: non-users 117.9 (95% CI 107.7 – 129.3) and users 22.9 (95% CI 10.3 – 50.9). After adjustment for age, sex, race, injection drug use (IDU), CD4, HIV RNA and cholesterol, progression was associated with statin use (Hazard ratio, HR 0.17, 95% CI 0.07 – 0.42), age (HR 1.03, 95% CI 1.02 – 1.05) and IDU (HR 1.27, 95% CI 1.02 – 1.59).
Although statin use was uncommon in our cohort, statins were associated with significantly lower incidence of liver disease progression. Accordingly, statins should be strongly considered in coinfected patients with indications for their use.
S. Mehta, None
R. Moore, None
M. Sulkowski, None