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Statin Use Might Reduce Risk of Cancer in HIV-Positive People

March 22, 2018

A large case-control analysis from the Veteran's Ageing Cohort Study (VACS) reported an overall association between statin use and a reduced risk of virus-mediated cancers in HIV-positive people.

Although mechanisms for statins to positively impact on the immune responses against tumor cells have been proposed, individual studies are often small. Several large meta-analysis conducted in the general population over the last five years, produced conflicting results, with only one study reporting a protective benefit against liver cancer.

Even when studies in HIV-positive people have reported a benefit, these have also sometimes included small numbers with limited follow-up, or with limited cancer-specific information.

The study presented at CROI 2018 by Roger Bedimo and colleagues, was a case-control analysis from 150,000 patients (97% male, one-third are HIV positive) in VACS. From this cohort, approximately 25,000 participants who used a statin were identified from 2001 to 2012 and matched 1:2 to 50,000 non-statin users.


Related: In a Large HIV Group, Only 36% of Those Needing Statins Received Statins

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A smaller propensity score model involving 24,000 participants (half using a statin and half not) included approximately 5,000 HIV-positive people vs 19,000 who were HIV negative, with follow-up continuing until first cancer diagnosis. This was to match for factors that were more likely to be associated with prescribing a statin, including age, calendar year, chronic infections and laboratory markers (LDL, albumin, Fib-4 index).

Cancer incidence was higher in the positive group (9.0% vs 7.1%). Cancers also occurred earlier in the HIV-positive group (after 3.6 vs 4.5 years) and later in people using a statin (4.9 vs 3.7 years).

Overall, the use of a statin was associated with a lower risk of all cancers, irrespective of HIV status, but with borderline significance of a greater impact for the HIV-positive group. See Table 1.

Virally mediated cancers (anal, oropharaynx, liver and NHL, but not Hodgkin's lymphoma) were all significantly reduced in the overall cohort, with larger reductions in anal and liver cancer reductions in the HIV negative group (both HR: 0.28; 95%CI: 0.10 to 0.82). Overall, non-virus cancers were also reduced (HR: 0.63; 95%CI: 0.57 to 0.70, p<0.0001)

Both overall and in subgroups, there were no cancers where statin use was associated with an increased risk.

Out of 4,431 incident deaths in the main cohort, statin use was also associated with a significantly reduced risk of death (HR: 0.55; 95%CI: 0.50 to 0.61).

In questions after the presentation, confounding by better socioeconomic states (in people receiving satins) was ruled out as the VACS is largely a low-income health provider. Further analysis are planned to look for whether individual statins have different effects.


Table 1: Statin Exposure and Risk of Cancer: By HIV Status and Cancer Type
Cancer type All participants

HR (95% CI)

p HIV negative

HR (95% CI)

HIV positive

HR (95% CI)

p for interaction
Any cancer
n=1799 0.61

(0.56 to 0.67)

<0.0001 0.65

(0.59 to 0.72)

0.51

(0.40 to 0.64)

0.051
AIDS-defining cancers
n=64 0.61

(0.56 to 0.67)

<0.0001 0.65

(0.59 to 0.72)

0.51

(0.40 to 0.64)

0.8
Non-AIDS defining cancers
n=1712 0.63

(0.58 to 0.69)

<0.0001 0.67

(0.60 to 0.74)

0.53

(0.41 to 0.67)

0.1


Comment

Even though statins are safe, effective and widely used, several studies have reported suboptimal management of cardiovascular risks in HIV-positive cohorts, perhaps linked to a reluctance to use statins.

These data might provide an additional reason to encourage their use.


Reference

Bedimo R et al. Statin exposure is associated with decreased risk of cancer. 25th CROI, 4 - 7 March 2018, Boston. Oral abstract 132.
www.croiconference.org/sessions/statin-exposure-associated-decreased-risk-cancer (abstract)
www.croiwebcasts.org/console/player/37301 (webcast)

[Note from TheBodyPRO: This article was originally published by HIV i-Base on March 21, 2018. We have cross-posted it with their permission.]




This article was provided by HIV i-Base. It is a part of the publication The 25th Conference on Retroviruses and Opportunistic Infections. Visit HIV i-Base's website to find out more about their activities, publications and services.
 


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