Atorvastatin (Lipitor)

Atorvastatin (Lipitor) is a statin that can reduce the levels of low-density lipoprotein (LDL or ‘bad’) cholesterol in the blood. This can reduce the risk of cardiovascular disease, including heart attacks and strokes. Statins work by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, which is resposible for the production of cholesterol.

Patients with liver disease or who are pregnant should not take statins. However, they are safe drugs in most patients. The main side-effects are muscle pain, as well as headache, altered liver function, tingling sensations, abdominal pain, flatulence, constipation, diarrhoea, nausea and vomiting.

Statins, including atorvastatin, are effective in the treatment of the alterations of blood fat levels due to treatment with anti-HIV drugs, particularly protease inhibitors.1 2 However, atorvastatin is broken down by the cytochrome P450 3A4 enzyme, and interacts with all available protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Protease inhibitors cause an increase in atorvastatin levels, increasing the risk of side-effects such as muscle pain and damage to the muscle fibres.3 4 5 Consequently, patients taking protease inhibitors should use another statin such as pravastatin sodium (Lipostat) or fluvastatin (Lescol) in place of atorvastatin, or they should use the lowest possible dose of atorvastatin with caution.

In contrast, NNRTIs reduce the levels of atorvastatin, putting patients at risk of poor anti-cholesterol effects.6 Patients taking an NNRTI and atorvastatin should have their dose of atorvastatin adjusted as required to keep cholesterol levels low.

Some experts believe that statins may have anti-HIV properties in their own right. However, a recent study found that atorvastatin failed to prevent CD4 cell count declines in patients interrupting anti-HIV treatment.7

References

  1. Murillas J et al. Atorvastatin for protease inhibitor-related hyperlipidaemia. AIDS 13: 1424, 1999
  2. Rosario P et al. Efficacy and safety of atorvastatin in the treatment of hypercholesterolemia associated with antiretroviral therapy. J Acquir Immune Defic Syndr 30: 536-537, 2002
  3. Carr TA et al. Concomitant administration of ABT-378 / ritonavir results in a clinically important pharmacokinetic interaction with atorvastatin but not pravastatin. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, abstract 1644, 2000
  4. Hsyu PH et al. Pharmacokinetic interactions between nelfinavir and 3-hydroxy-3-methylglutaryl coenzyme A inhibitors atorvastatin and simvastatin. Antimicrob Agents Chemother 45: 3445-3450, 2001
  5. van Heeswijk R et al. The pharmacokinetic interactions between tipranavir / ritonavir 500 / 200 mg bid (TPV / r) and atorvastatin, antacid and CYP3A4 in healthy adult volunteers. Fifth International Workshop on Clinical Pharmacology of HIV Therapy, Rome, abstract 5.2, 2004
  6. Gerber JG et al. Effect of efavirenz on the pharmacokinetics of simvastatin, atorvastatin and pravastatin. Results of AIDS Clinical Trials Group 5108 Study. J Acquir Immune Defic Syndr 39: 307-312, 2005
  7. Negredo E et al. The effect of atorvastatin treatment on HIV-1-infected patients interrupting antiretroviral therapy. AIDS 20: 619-621, 2006

Up a level
Back to contents
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.