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We have 2 comments on the article of Ballantyne et al¹ regarding the risk of myopathy with statin therapy in high-risk patients. First, in their discussion related to the interaction of statins with other drugs that interfere with cytochrome CYP3A4 pathways, the authors did not mention the interaction of statins with protease inhibitors, particularly ritonavir, a potent inhibitor of cytochrome CYP3A4.² In fact, hyperlipidemia is a common metabolic complication encountered in human immunodeficiency virus–infected patients as result of treatment with protease inhibitors.³ In our experience, the degree of dyslipidemia is sometimes severe enough to require maximum doses of statins. Preliminary pharmacokinetic studies showed an increase in the area under the plasma concentration time curve (AUC) of 32-fold for simvastatin and of 4.5-fold for atorvastatin when administered concomitantly with the combination of ritonavir and saquinavir.⁴ Conversely, a 0.5-fold decrease in the AUC was observed for pravastatin, which is not metabolized via . . . [Full Text of this Article]

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