Statin use and impact on tuberculosis risk

ABSTRACT

Introduction: Tuberculosis, a chronic infection caused by Mycobacterium tuberculosis (MTB), is one of the 10 leading causes of death in the world. The current treatment is a combination antimicrobial therapy administered for 6–9 months. It is important to find therapeutic strategy to shorten the treatment during and strengthen the host immune response against MTB.

Areas covered: There is evidence that MTB uses cholesterol in the host macrophage to infect and survive inside the host macrophage. Statins inhibit the synthesis of cholesterol and aid in reducing the levels of cholesterol in human, which have been associated with better outcome in infectious diseases. In this narrative review, we discuss recent studies that investigated the effects of statins on the prevention or treatment of TB infection.

Expert opinion: The evaluation of the published evidence suggests that statins may be beneficial in the treatment of patients with TB infections. Future studies may focus not only on the beneficial effects of statins, but also on distinguishing the effects of different statins.

KEYWORDS:

• HMG-CoA reductase inhibitor
• statin
• tuberculosis
• pneumonia
• Mycobacterium tuberculosis
• metformin
• diabetes mellitus

Article highlights

• Tuberculosis (TB) infection is one of the 10 leading causes of death in the world. It is important to find therapeutic strategy to strengthen TB treatment.

• Mycobacterium tuberculosis (MTB) uses cholesterol to infect and survive inside the host macrophage. Statins inhibit the synthesis of cholesterol and are associated with better outcome in many infectious diseases.

• Interestingly, several retrospective cohort studies have confirmed the protective effects of statins on the TB infections in the general population. Statins use was dose-dependently associated with a lower TB infection risk in the general population.

• As statins potentially have anti-TB effects and have been used widely in patients with diabetes, investigation of their impact on the TB infection risk in this population is worthwhile. However, the effects of statin use on TB infection risk in patients with diabetes remain uncertain.

• Some clinical studies showed that statin use was associated with a lower risk of TB development in the diabetes population.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

V-Y Su had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Analysis and interpretation of data: V-Y Su, S-W Pan. Drafting of the manuscript: V-Y Su, S-W Pan. Study supervision: W-J Su, Y-F Yen, J-Y Feng, Y-M Chen. Vincent Y.F. Su and S.W. Pan contributed equally to this study.

Additional information

Funding

This paper was not funded.