Answer: C. Fluvastatin
In 2014, the FDA issued a warning3 about the use of statins with protease inhibitors and non-nucleoside reverse transcriptase inhibitors. For these drugs, interactions are usually specific to the statins via the CYP3A4 pathway. Current guidelines from the National Institutes of Health4 recommended using fluvastatin, pitavastatin, and pravastatin over lovastatin and simvastatin with these drugs, and using atorvastatin and rosuvastatin with caution. The efficacy of some statins will increase while that of other will decrease when taken in combination with non-nucleoside reverse transcriptase inhibitors.
1. Kellick KA, Bottorff M, Toth PP, The National Lipid Association's Safety Task Force. A clinician's guide to statin drug-drug interactions. J Clin Lipidol. 2014;8:S30-46.
2. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2013;63:2889-2934.
3. US Food and Drug Administration. FDA Drug Safety Communication: interaction between certain HIV or hepatitis C drugs and cholesterol-lowering statin drugs can increase the risk of muscle injury. http://www.fda.gov/Drugs/DrugSafety/ucm293877.htm. Published March 1, 2012. Acessed May 8, 2018.
4. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. US Department of Health and Human Services. Available at https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl003093.pdf. Accessed May 18, 2018.