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Statin exposure and risk of cancer in people with and without HIV infection.

OBJECTIVE
To determine whether statin exposure is associated with decreased cancer and mortality risk among persons with HIV (PWH) and uninfected persons. Statins appear to have immunomodulatory and anti-inflammatory effects and may reduce cancer risk, particularly among PWH as they experience chronic inflammation and immune activation.


DESIGN
Propensity score matched cohort of statin-exposed and unexposed patients from 2002-2017 in the Veterans Aging Cohort Study (VACS), a large cohort with cancer registry linkage and detailed pharmacy data.


METHODS
We calculated Cox regression hazard ratios (HRs) and 95% confidence intervals (CI) associated with statin use for all cancers, microbial cancers (associated with bacterial or oncovirus coinfection), non-microbial cancers, and mortality.


RESULTS
The propensity score-matched sample (N = 47,940) included 23,970 statin initiators (31% PWH). Incident cancers were diagnosed in 1,160 PWH and 2,116 uninfected patients. Death was reported in 1,667 (7.0%) statin-exposed, and 2,215 (9.2%) unexposed patients. Statin use was associated with 24% decreased risk of microbial associated cancers (HR 0.76; 95% CI 0.69-0.85), but was not associated with non-microbial cancer risk (HR 1.00; 95% CI 0.92-1.09). Statin use was associated with 33% lower risk of death overall (HR 0.67; 95% CI 0.63-0.72). Results were similar in analyses stratified by HIV status, except for non-Hodgkin lymphoma where statin use was associated with reduced risk (HR 0.56; 95% CI 0.38-0.83) for PWH, but not for uninfected (p-interaction = 0.012).


CONCLUSIONS
In both PWH and uninfected, statin exposure was associated with lower risk of microbial, but not non-microbial cancer incidence, and with decreased mortality.