Evolution of blood-associated HIV-1 DNA levels after 48 weeks of switching to atazanavir/ritonavir+lamivudine dual therapy versus continuing triple therapy in the randomized AtLaS-M trial

Francesca Lombardi, Simone Belmonti, Eugenia Quiros-Roldan, Alessandra Latini, Antonella Castagna, Gabriella D'Ettorre, Roberta Gagliardini, Massimiliano Fabbiani, Roberto Cauda, Andrea De Luca, Simona D. Di Giambenedetto, Andrea Giacometti, Massimo Di Pietro, Maria Teresa Mughini, Pierfrancesco Grima, Claudio Viscoli, Paolo Emilio Manconi, Massimo Puoti, Massimo Galli, Pierluigi VialeAndrea Gori, Giuliano Rizzardini, Maurizio Mineo, Andrea Antinori, Nicola Petrosillo, Vincenzo Vullo, Maria Stella Mura, Pietro Caramello, Pier Giorgio Scotton, Ercole Concia, Adriano Lazzarin, Daniela Francisci, Daria Sacchini, on behalf of the AtLaS-M Study Group

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The AtLaS-M randomized trial showed that in patients with HIV-1 RNA <50 copies/mL on atazanavir/ ritonavir + two NRTIs, switching to a dual therapy with atazanavir/ritonavir+lamivudine had superior efficacy as compared with continuing the previous triple therapy. This substudy was designed to evaluate at 48 weeks the impact of the dual therapy versus the three-drug atazanavir/ritonavir-based therapy on the HIV-1 cellular reservoir as reflected by the quantification of blood-associated HIV-1 DNA levels. Methods: In a representative subset of 201 of 266 randomized patients (104 in the dual-therapy arm and 97 in the triple-therapy arm) total HIV-1 DNA levels in whole blood at baseline and after 48 weeks and factors associated with the HIV-1 DNA levels were evaluated. Results: The mean baseline HIV-1 DNA levels (2.47 log10 copies/106 leucocytes) were comparable between arms. A significant mean decrease between baseline and week 48 was observed: -0.069 log10 copies/106 leucocytes in the dual-therapy arm (P=0.046) and -0.078 in the triple-therapy arm (P=0.011); the mean difference between arms was -0.009 (P=0.842). Nadir CD4 count was inversely correlated with baseline HIV-1 DNA (P=0.009); longer duration of ART and lower nadir CD4 correlated with a less prominent HIV-1 DNA decrease (both P<0.005). Higher baseline HIV-1 DNA was associated with residual viraemia at week 48 (P=0.031). Conclusions: When compared with continuing three-drug therapy, atazanavir/ritonavir+lamivudine dual therapy resulted in a similar decline in HIV-1 DNA levels in patients with sustained virological suppression. These data support the safety of this simplified treatment strategy in terms of its effect on the cellular HIV-1 reservoir.

Original languageEnglish
Article numberdkx068
Pages (from-to)2055-2059
Number of pages5
JournalJournal of Antimicrobial Chemotherapy
Volume72
Issue number7
DOIs
Publication statusPublished - Jul 1 2017

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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