TY - JOUR
T1 - Efficacy and safety of a switch to unboosted atazanavir in combination with nucleoside analogues in HIV-1-infected patients with virological suppression under antiretroviral therapy
AU - Pavie, Juliette
AU - Porcher, Raphael
AU - Torti, Carlo
AU - Medrano, José
AU - Castagna, Antonella
AU - Valin, Nadia
AU - Rusconi, Stefano
AU - Ammassari, Adriana
AU - Ghosn, Jade
AU - Delaugerre, Constance
AU - Molina, Jean Michel
AU - Franzetti, Marco
AU - Lascoux-combes, Caroline
AU - Lorenzini, Patrizia
AU - Carosi, Giampiero
AU - Albini, Laura
AU - Nasta, Paola
AU - Quiros-roldan, Eugenia
AU - Castelnuovo, Filippo
AU - Rachline, Anne
PY - 2011/10
Y1 - 2011/10
N2 - Background: Limited data are available on the use of unboosted atazanavir in combination with nucleoside reverse transcriptase inhibitors (NRTIs) in treatment-experienced HIV-infected patients. Methods: We conducted a multicentre, retrospective study among patients with plasma HIV-1 RNA levels>50 copies/mL under antiretroviral therapy who switched to unboosted atazanavir+NRTIs between January 2002 and December 2008. Virological failure during follow-up was defined as a confirmed plasma HIV-1 RNA level >50 copies/mL. Baseline risk factors for virological failure were identified using Cox proportional hazards models. Results: A total of 886 patients were analysed. At baseline, median age was 44 years, 71.5% were males and median CD4 cell count was 490 cells/mm 3. NRTIs used in combination with atazanavir were tenofovir, abacavir and emtricitabine/lamivudine in 36.9%, 44.1% and 94.4% of patients, respectively. Median follow-up was 21 months. The 3 year probability of virological failure was 20.1%. Only a history of virological failure under NRTIs [hazard ratio (HR) 1.63, P=0.049] and under protease inhibitors (HR 2.04, P=0.006) were significantly associated with the risk of virological failure. Among the 431 patients without a prior history of virological failure, the 3 year probability of virological failure was 11.3%, and only hepatitis C virus co-infection (HR 2.25, P=0.026) and abacavir use (HR 0.43, P=0.04) were associated with the risk of virological failure. Safety of the switch was satisfactory, with improvement of the lipid profile. Conclusions: In patients with virological suppression and no prior history of virological failure, a switch to unboosted atazanavir in combination with NRTIs is associated with a low probability of virological failure and a good safety profile.
AB - Background: Limited data are available on the use of unboosted atazanavir in combination with nucleoside reverse transcriptase inhibitors (NRTIs) in treatment-experienced HIV-infected patients. Methods: We conducted a multicentre, retrospective study among patients with plasma HIV-1 RNA levels>50 copies/mL under antiretroviral therapy who switched to unboosted atazanavir+NRTIs between January 2002 and December 2008. Virological failure during follow-up was defined as a confirmed plasma HIV-1 RNA level >50 copies/mL. Baseline risk factors for virological failure were identified using Cox proportional hazards models. Results: A total of 886 patients were analysed. At baseline, median age was 44 years, 71.5% were males and median CD4 cell count was 490 cells/mm 3. NRTIs used in combination with atazanavir were tenofovir, abacavir and emtricitabine/lamivudine in 36.9%, 44.1% and 94.4% of patients, respectively. Median follow-up was 21 months. The 3 year probability of virological failure was 20.1%. Only a history of virological failure under NRTIs [hazard ratio (HR) 1.63, P=0.049] and under protease inhibitors (HR 2.04, P=0.006) were significantly associated with the risk of virological failure. Among the 431 patients without a prior history of virological failure, the 3 year probability of virological failure was 11.3%, and only hepatitis C virus co-infection (HR 2.25, P=0.026) and abacavir use (HR 0.43, P=0.04) were associated with the risk of virological failure. Safety of the switch was satisfactory, with improvement of the lipid profile. Conclusions: In patients with virological suppression and no prior history of virological failure, a switch to unboosted atazanavir in combination with NRTIs is associated with a low probability of virological failure and a good safety profile.
KW - Abacavir
KW - Simplification
KW - Tenofovir
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U2 - 10.1093/jac/dkr316
DO - 10.1093/jac/dkr316
M3 - Article
C2 - 21821627
AN - SCOPUS:80052871466
VL - 66
SP - 2372
EP - 2378
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
SN - 0305-7453
IS - 10
M1 - dkr316
ER -