A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy

Kabelo Mokgalaboni; Wendy Nokhwezi Phoswa; Samantha Yates; Sogolo Lucky Lebelo; Sphiwe Madiba; Perpetua Modjadji

doi:10.3390/ijerph20095668

A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy

Int J Environ Res Public Health. 2023 Apr 27;20(9):5668. doi: 10.3390/ijerph20095668.

Authors

Kabelo Mokgalaboni¹, Wendy Nokhwezi Phoswa¹, Samantha Yates¹, Sogolo Lucky Lebelo¹, Sphiwe Madiba², Perpetua Modjadji³

Affiliations

¹ Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa.
² Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa.
³ Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa.

Abstract

The rate of new human immunodeficiency virus (HIV) infections globally is alarming. Although antiretroviral therapy (ART) improves the quality of life among this group of patients, ARTs are associated with risk of cardiovascular diseases (CVD). Moreover, virally suppressed patients still experience immune activation associated with HIV migration from reservoir sites. Statins are widely recommended as therapeutic agents to control ART-related CVD; however, their impacts on the cluster of differentiation (CD)4 count and viral load are inconsistent. To assess the effect of statins on markers of HIV infections, immune activation and cholesterol, we thoroughly reviewed evidence from randomised controlled trials. We found 20 relevant trials from three databases with 1802 people living with HIV (PLHIV) on statin-placebo treatment. Our evidence showed no significant effect on CD4 T-cell count standardised mean difference (SMD): (-0.59, 95% confidence intervals (CI): (-1.38, 0.19), p = 0.14) following statin intervention in PLHIV on ART. We also found no significant difference in baseline CD4 T-cell count (SD: (-0.01, 95%CI: (-0.25, 0.23), p = 0.95). Our findings revealed no significant association between statins and risk of viral rebound in PLHIV with undetectable viral load risk ratio (RR): (1.01, 95% CI: (0.98, 1.04), p = 0.65). Additionally, we found a significant increase in CD8⁺CD38⁺HLA-DR⁺ T-cells (SMD (1.10, 95% CI: (0.93, 1.28), p < 0.00001) and CD4⁺CD38⁺HLA-DR⁺ T-cells (SMD (0.92, 95% CI: (0.32, 1.52), p = 0.003). Finally, compared to placebo, statins significantly reduced total cholesterol (SMD: (-2.87, 95% CI: (-4.08, -1.65), p < 0.0001)). Our results suggest that the statin lipid-lowering effect in PLHIV on ART may elevate immune activation without influencing the viral load and CD4 count. However, due to the limited evidence synthesised in this meta-analysis, we recommend that future powered trials with sufficient sample sizes evaluate statins' effect on CD4 count and viral load, especially in virally suppressed patients.

Keywords: CD4 count; HIV; antiretroviral therapy; immune activation; statin; viremia.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

CD4 Lymphocyte Count
Cardiovascular Diseases* / complications
Cardiovascular Diseases* / prevention & control
Cholesterol
HIV Infections* / complications
HIV-1*
HLA-DR Antigens
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Quality of Life
Viral Load

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
HLA-DR Antigens
Cholesterol

Grants and funding

This research received no external funding.