Are Statins Neuroprotective in HIV Patients?

Neither statin therapy nor angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy affects global neurocognitive function in patients with human immunodeficiency virus (HIV), according to a recent study. However, both therapies are associated with modest declines in neurocognitive performance in single domains.

Although they are generally well-tolerated, the effects of statins and ACEIs/ARBs on neurocognitive function in patients with HIV is not yet known.
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To explore this further, the researchers evaluated 3949 participants enrolled in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. All patients included in the study had not received a statin or ACEI/ARB within 30 days prior to baseline and had available NPZ-3 scores, or the z score of averaged Trailmaking A and B tests and digit symbol test (DST) scores, from at least 2 measurements.

During the study period, 16% of participants had started therapy with a statin, 11% had started with an ACEI/ARB, and 5% started with both. The primary outcome was the composite NPZ-3.

Results demonstrated that statin therapy had no significant impact on the composite NPZ-3, Trailmaking B test, or DST score. However, the researchers observed a small, nonsignificant positive effect on the Trailmaking A test during year 1, and a small but significant negative impact in each subsequent year.

Additionally, they found that ACEI/ARB therapy had a significant negative impact on DST score during year 1 but minimal impact in the following years or on other neurocognitive domains.

“In summary, although modest declines in neurocognitive performance were seen in single domains with statin or ACEI/ARB therapy, we did not find consistent evidence that statins or ACEI/ARB have an effect on global neurocognitive function,” the researchers concluded. “Future studies should focus on long-term neurocognitive effects.”

—Christina Vogt

Reference:

Erlandson KM, Kitch D, Wester CW, et al. The impact of statin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy on cognitive function in adults with human immunodeficiency virus infection. Clin Infect Dis. 2017;65(12):2042-2049. https://doi.org/10.1093/cid/cix645.