While rosuvastatin is poorly metabolised by CYP3A4, an increase of its plasma concentrations was observed. The mechanism of this interaction may result from inhibition of transport proteins. Coadministration increased rosuvastatin AUC by 2-fold and increased Cmax by 5-fold. Caution should be exercised and reduced doses should be considered when Kaletra is coadministered with rosuvastatin. If treatment with a HMG-CoA reductase inhibitor is indicated, pravastatin or fluvastatin is recommended.
Kaletra Summary of Product Characteristics, AbbVie Ltd, January 2021.

Coadministration of lopinavir/ritonavir (400/100 mg twice daily) and rosuvastatin (20 mg once daily) was studied in 15 HIV- subjects. Rosuvastatin Cmax, AUC and Cmin increased by 366%, 108% and 4%, respectively. Titrate rosuvastatin dose carefully and use the lowest necessary dose; do not exceed rosuvastatin 10 mg/day.
Kaletra Prescribing Information, AbbVie Ltd, October 2020.

A case report describes an HIV-1 infected patient with moderate renal failure (CrCl 38 ml/min) receiving tenofovir (once every other day) with abacavir and lopinavir/ritonavir (both twice daily).  The patient was switched from pravastatin to rosuvastatin because of vascular pathology.  Other drugs included tamsulosin, gemfibrozil, amitriptyline and ciprofloxacin.  Based on laboratory evaluation the patient was diagnosed with rhabdomyolysis and ART, ciprofloxacin and rosuvastatin were discontinued.  Eventually ART was restarted 16 days after hospital admission and consisted of atazanavir/ritonavir, abacavir and raltegravir. Pravastatin replaced rosuvastatin.  The authors discuss possible factors that may have contributed to the development of rhabdomyolysis, i.e. i) rosuvastatin is a substrate of OATP1B1 which can be inhibited by lopinavir/ritonavir and gemfibrozil and ii) a possible increase in tenofovir exposure due to lopinavir/ritonavir which may have contributed to the a decline in renal function and an increased risk of rhabdomyolysis.  Replacing lopinavir/ritonavir and rosuvastatin was important for management and there was an important role for raltegravir.
Rhabdomyolysis in an HIV-infected patient with impaired renal function concomitantly treated with rosuvastatin and lopinavir/ritonavir. de Kanter CTMM, Keuter M, van der Lee MJ, et al. Antiviral Ther, 2011, 16(3): 435-437.

This study explored the lipid-lowering effect of rosuvastatin and assessed the effect of lopinavir/ritonavir on the pharmacokinetics of rosuvastatin and vice versa. HIV+ patients (n=20) on lopinavir/ritonavir with total cholesterol >6.2 mmol/L were treated with rosuvastatin for 12 weeks, starting with 10 mg once daily. If fasting target values of total, HDL or LDL cholesterol or triglycerides were not reached, rosuvastatin was escalated to 20 mg or 40 mg at weeks 4 and 8, respectively. Plasma lopinavir and ritonavir trough concentrations (Cmin) were determined at weeks 0, 4, 8 and 12, and rosuvastatin Cmin at weeks 4, 8 and 12. Rosuvastatin was found not to influence lopinavir or ritonavir concentrations. Median (IQR) rosuvastatin Cmin for 10 mg, 20 mg and 40 mg were 0.97 (0.70-1.5), 2.5 (1.3-3.3) and 5.5 (3.3-8.8) ng/ml, respectively and were 1.6-fold higher than in historical healthy subjects. The authors conclude that until safety and efficacy have been confirmed in larger studies, the combination of rosuvastatin and lopinavir/ritonavir should be used with caution.
Pharmacokinetics and pharmacodynamics of combined use of lopinavir/ritonavir and rosuvastatin in HIV-infected patients. van der Lee M, Sankatsing R, Schippers E, et al. Antiviral Ther, 2007, 12: 1127-1132.

Coadministration of lopinavir (400/100 mg twice daily) and rosuvastatin (20 mg once daily) was studied in 15 HIV- subjects. Lopinavir and ritonavir AUC and Cmax were unaffected by rosuvastatin. Rosuvastatin AUC and Cmin were unexpectedly increased by 2.1- and 4.7-fold in the presence of lopinavir/ritonavir/r. The LDL lowering effects of rosuvastatin were attenuated with lopinavir/ritonavir (40% vs 27% decrease, alone vs +lopinavir/ritonavir) despite the increase in exposure. The mechanism of the interaction is not known and the authors suggest the possible dose separation to mitigate the interaction.
Drug-drug interaction between lopinavir/ritonavir and rosuvastatin. Hoody D, et al. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, February 2007, abstract 564.