Question

My doctor recently advised me to start taking Lipitor. My cholesterol hovers around 200. He said research has shown a benefit with those with HIV. I'm on Genvoya, 64 years old and have been undetectable for 8 years and after a month on Lipitor I developed muscle aches. I started reading about Lipitor side effects which can cause muscle damage and diabetes. One article went so far to say that HIV people should not take the STATIN class of medications, which Lipitor is. I stopped taking Lipitor and the muscle and joint pain went away.

Do you have an opinion or experience with this?
Thank you so much.

Answer

Hello and thanks for posting your important questions.

It's important to understand that people living with HIV appear to be at greater risk of cardiovascular disease (CVD), like heart disease and stroke. Because of this, optimal management of CVD risks (such as tobacco, blood pressure, diabetes, diet/exercise and cholesterol) is an essential part of preventive healthcare.

One of the most important aspects to CVD prevention is control of HIV viral load, and preferably, initiation of treatment before CD4 count is low.

Cholesterol lowering, through prudent diet, and when necessary, medications is a central part of CVD prevention. The US Preventive Services Task Force have draft recommendations that recommends statin use in adults without a history of CVD (i.e., symptomatic coronary artery disease or thrombotic stroke) use a low- to moderate-dose statin for the prevention of CVD events when all of the following criteria are met: (1) They are ages 40 to 75 years; (2) They have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking); (3) They have a calculated 10-year risk of a cardiovascular event of 10% or greater. (Full draft recommendations are
available here.). Statins are not recommended for all- in part because of side effect risks that you've noted; but overall, in those people with substantial heart disease risks, the benefits of statins continues to outweigh these risks.

I'm not aware of any recommendations that positive people avoid statins, but rather that their use be part of a comprehensive view of CVD risks and reduction of reversible risks. I recommend looking at all of your risks, including using the American Heart Association risk calculator. Once you know your estimated CVD risk, the level of intervention, including at what LDL cholesterol it's recommended to use statins can be determined for your individual case.

For more information about managing and preventing CVD in people living with HIV, check out our pages at myHIVclinic.org.

I hope that's helpful, BY