Lipid Metabolism and Cardiovascular Risk in HIV-1 Infection and HAART: Present and Future Problems

Table 3

Interactions between statins and protease inhibitors or nonnucleoside reverse transcripted inhibitors, from the DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, revised Dec. 1, 2009. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.

Interactions of statins with PIs
Atorvastatin	All PIs	DRV/r ↑ 4 folds atorvastatin AUCFPV +/− r ↑ atorvastatin AUC by 130–153%; LPV/r ↑ atorvastatin AUC by 488%; NFV ↑ atorvastatin AUC by 74%; SQV/r ↑ atorvastatin AUC by 79%; TPV/r ↑ atorvastatin AUC by 836%	Use lowest possible starting dose with careful monitoring for toxicities or consider other HMG-CoA reductase inhibitors with less potential for interaction.
Lovastatin	All PIs	Significant ↑ lovastatin expected	Contraindicated—do not coadminister.
Pravastatin	DRV/r	pravastatin AUC ↑ 81%	Use lowest possible starting dose with careful monitoring.
	LPV/r	pravastatin AUC ↑ 33%	No dose adjustment necessary
		pravastatin AUC ↓ 47–50%	No dose adjustment necessary
Rosuvastatin	ATV/r	rosuvastatin AUC ↑ 213% and Cmax ↑ 600%	Use lowest possible starting dose with careful monitoring or consider other HMG-CoA reductase inhibitors with less potential for interaction.
	DRV/r, IDV +/− r,; NFV, SQV/r	↑ rosuvastatin possible
	FPV +/− r	No significant change	No dosage adjustment necessary
	LPV/r	rosuvastatin AUC ↑ 108% and Cmax ↑ 366%	Use lowest possible starting dose with careful monitoring or consider other HMG-CoA reductase inhibitors with less potential for interaction.
	TPV/r	rosuvastatin AUC ↑ 26% and Cmax ↑ 123%
Simvastatin	All PIs	Significant ↑ simvastatin level; NFV ↑ simvastatin AUC 505%; SQV/r 400/400 mg BID ↑ simvastatin AUC 3,059%	Contraindicated—do not coadminister.
Interactions of statins with NNRTIs
Atorvastatin	EFV, ETR, NVP	atorvastatin AUC ↓ 32%–43% with EFV, ETR	Adjust atorvastatin according to lipid responses, not to exceed the maximum recommended dose.
Fluvastatin	ETR	↑ fluvastatin possible	Dose adjustments for fluvastatin may be necessary.
Lovastatin; Simvastatin	EFV	simvastatin AUC ↓ 68%	Adjust simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
	ETR	↓ lovastatin possible; ↓ simvastatin possible	Adjust lovastatin or simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
	NVP	↓ lovastatin possible; ↓ simvastatin possible	Adjust lovastatin or simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
Pravastatin; Rosuvastatin	EFV	pravastatin AUC ↓ 44%; rosuvastatin: no data	Adjust statin dose according to lipid responses, not to exceed the maximum recommended dose.
	ETR	No significant effect expected	No dosage adjustment necessary