Objective: Experimental studies suggested that HMG-CoA reductase inhibitors ('statins’) may have antilymphoma properties. We investigated whether statin use is associated with reduced risk of non-Hodgkin lymphoma (NHL) in HIV-positive persons.
Design: A nested case–control study was conducted among HIV-positive members of Kaiser Permanente California, a large managed care organization.
Methods: Cases were incident HIV+ NHL diagnosed from 1996 to 2008. Controls were HIV-positive members without NHL matched 5 : 1 to cases by age, sex, race, index year and known duration of HIV infection. Data were collected from Kaiser Permanente's electronic medical records. Conditional logistic regression was used to examine the effect of statin use on HIV + NHL risk, adjusting for potential confounders (matching factors, prior clinical AIDS diagnosis, antiretroviral use, baseline CD4 cell count, and history of selected co-morbidity) and use of nonstatin lipid-lowering therapy (LLT).
Results: A total of 259 cases and 1295 controls were included. Eight percent of the cases and 14% of the controls had a history of statin use. Statin use was associated with lower risk of HIV + NHL; hazard ratio and 95% confidence intervals for ever use, less than 12, and at least 12 months cumulative use was 0.55 (0.31–0.95), 0.64 (0.31–1.28), and 0.50 (0.23–1.10), respectively. P value for trend for duration of statin use was 0.08. No association between nonstatin LLT use and risk of NHL was observed.
Conclusion: Our results suggested an inverse association between statin use and risk of NHL in HIV-positive persons. Potential limitations include the likelihood of residual confounding by indication and limited study power for some statin use subgroups.
aDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
bDivision of Hematology-Oncology, San Francisco General Hospital, University of California, San Francisco
cLos Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
dDivision of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Correspondence to Chun Chao, PhD, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Avenue, Suite 200, Pasadena, CA 91101, USA. Tel: +1 626 564 3797; fax: +1 626 564 3409; e-mail: email@example.com
Received 26 January, 2011
Revised 31 May, 2011
Accepted 10 June, 2011