Pravastatin sodium (Lipostat)

Pravastatin sodium (Lipostat) is a statin that can lower cholesterol levels in the blood and reduce the risk of heart attacks and strokes. It is a very widely-used drug, because it is very safe and effective. In the United States, it is marketed as Pravachol.

The standard dose of pravastatin is 10 to 40mg once a day.

Side-effects of pravastatin are rare, but include inflammation of the muscle, liver problems and upset stomach.

Pravastatin can be used to reduce the blood cholesterol elevations that can occur as a side-effect of treatment with anti-HIV drugs, particularly protease inhibitors. In one study, pravastatin reduced blood cholesterol levels after four weeks of treatment. In addition, it reversed fat loss from under the skin.1 Pravastatin can reduce cholesterol levels more effectively than can switching from protease inhibitor-based to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based treatment, as well as reducing early signs of cardiovascular disease.2 3 This suggests that pravastatin can improve the metabolic changes occurring with HIV treatment, as well as improve fat redistribution – however, the mechanism of this latter effect is unknown, and requires confirmation in larger randomised studies.

Despite theories that pravastatin itself may have some anti-HIV properties, adding pravastatin to antiretroviral therapy does not cause any further reductions in HIV viral loads.4

In contrast to some other members of the statin class, pravastatin is not metabolised through the CYP3A4 enzyme. It therefore has few interactions with anti-HIV drugs, and can be taken safely by patients taking protease inhibitors.5 6 7 However, the NNRTI efavirenz (Sustiva) can reduce pravastatin levels, which may require a higher dose to keep cholesterol levels low.8

References

  1. Mallon PWG et al. Effect of pravastatin on body composition and markers of cardiovascular disease in HIV-infected men – a randomized, placebo-controlled study. AIDS 20: 1003-1010, 2006
  2. Calza L et al. Substitution of nevirapine or efavirenz for protease inhibitor versus lipid-lowering therapy for the management of dyslipidaemia. AIDS 19: 1051-1058, 2005
  3. Stein JH et al. Effects of pravastatin on lipoproteins and endothelial function in patients receiving human immunodeficiency virus protease inhibitors. Am Heart J 147: E18, 2004
  4. Sklar PA et al. Pravastatin does not have a consistent antiviral effect in chronically HIV-infected individuals on antiretroviral therapy. AIDS 19: 1109-1112, 2005
  5. Benesic A et al. Lipid lowering therapy with fluvastatin and pravastatin in patients with HIV infection and antiretroviral therapy: comparison of efficacy and interaction with indinavir. Infection 32: 229-233, 2004
  6. Moyle GJ et al. Pravastatin does not alter protease inhibitor exposure or virologic efficacy during a 24-week period of therapy. J Acquir Immune Defic Syndr 30: 4, 2002
  7. Fichtenbaum CJ et al. Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG study A5047. AIDS 16: 569-577, 2002
  8. 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

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Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

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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
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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.