Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study

Josep Maria Llibre, Alessandro Cozzi-Lepri, C. Pedersen, M. Ristola, M. Losso, Amanda Mocroft, Viktar Mitsura, Karolin Falconer, F. Maltez, M. Beniowski, V. Vullo, Gamal Hassoun, Elena Kuzovatova, János Szlávik, A. Kuznetsova, H. J. Stellbrink, C. Duvivier, Simon Edwards, Kamilla Laut, Roger ParedesM. Losso, M. Kundro, N. Vetter, Robert Zangerle, I. Karpov, A. Vassilenko, V. M. Mitsura, D. Paduto, Nathan Clumeck, Stéphane De Wit, M. Delforge, E. Florence, L. Vandekerckhove, V. Hadziosmanovic, K. Kostov, J. Begovac, L. Machala, D. Jilich, D. Sedlacek, G. Kronborg, T. Benfield, J. Gerstoft, T. Katzenstein, Nina Friis Moller, Court Pedersen, L. Ostergaard, Ulrik B. Dragsted, L. N. Nielsen, K. Zilmer, J. Smidt, M. Ristola, I. Aho, J. P. Viard, Pierre Marie Girard, L. Cotte, C. Pradier, Eric Fontas, F. Dabis, D. Neau, C. Duvivier, J. Rockstroh, R. E. Schmidt, O. Degen, H. J. Stellbrink, C. Stefan, J. R. Bogner, Gerd Fätkenheuer, N. Chkhartishvili, J. Kosmidis, P. Gargalianos, G. Xylomenos, P. Lourida, H. Sambatakou, J. Szlávik, M. Gottfredsson, F. Mulcahy, I. Yust, D. Turner, M. Burke, E. Shahar, G. Hassoun, H. Elinav, M. Haouzi, D. Elbirt, Z. Sthoeger, A. D'Arminio Monforte, R. Esposito, I. Mazeu, Cristina Mussini, F. Mazzotta, Andrea Gabbuti, Vincenzo Vullo, Miriam Lichtner, Mauro Zaccarelli, A. Antinori, R. Acinapura, M. Plazzi, Adriano Lazzarin, Antonella Castagna, Nicola Gianotti, Massimo Galli, Annalisa Ridolfo, B. Rozentale, V. Uzdaviniene, R. Matulionyte, T. Staub, R. Hemmer, Peter Reiss, V. Ormaasen, A. Maeland, J. Bruun, Brygida Knysz, J. Gasiorowski, M. Inglot, A. Horban, E. Bakowska, R. Flisiak, A. Grzeszczuk, M. Parczewski, M. Pynka, K. Maciejewska, M. Beniowski, E. Mularska, T. Smiatacz, M. Gensing, E. Jablonowska, E. Malolepsza, K. Wojcik, I. Mozer-Lisewska, M. Doroana, L. Caldeira, K. Mansinho, F. Maltez, R. Radoi, C. Oprea, A. Rakhmanova, A. Rakhmanova, T. Trofimora, I. Khromova, E. Kuzovatova, D. Jevtovic, A. Shunnar, D. Staneková, J. Tomazic, J. M. Gatell, Jose Miro, Santiago Moreno, J. M. Rodriguez, Bonaventura Clotet, A. Jou, R. Paredes, C. Tural, J. Puig, I. Bravo, P. Domingo, M. Gutierrez, G. Mateo, M. A. Sambeat, J. M. Laporte, K. Falconer, A. Thalme, Anders Sönnerborg, A. Blaxhult, L. Flamholc, B. Ledergerber, R. Weber, M. Cavassini, A. Calmy, Hansjakob Furrer, Manuel Battegay, P. Schmid, E. Kravchenko, V. Frolov, G. Kutsyna, I. Baskakov, A. Kuznetsova, G. Kyselyova, M. Sluzhynska, B. Gazzard, Anne M. Johnson, E. Simons, S. Edwards, A. N. Phillips, Margaret Johnson, Amanda Mocroft, C. Orkin, Jonathan Weber, G. Scullard, Amanda Clarke, C. Leen, J. D. Lundgren, Jesper Grarup, Rodolphe Thiebaut, D. M. Burger, L. Peters, C. Matthews, Aurelie Fischer, A. Bojesen, D. Raben, D. Kristensen, J. F. Larsen, D. Podlekareva, L. Shepherd, A. Schultze

Research output: Contribution to journalArticle

Abstract

Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant. We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50copies/mL. We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28%), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10%). Ninety (32%) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90%/87%/88% (TLOVR) and 74%/67%/59% (snapshot analysis), respectively. The rates of VF were 8%/8%/6%. Rates of adverse events leading to study discontinuation were 0.4%/1%/2%. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95% confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50copies/mL (HR 0.87 [95% CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95% CI: 1.28-6.04]). Resistance selection at failure was uncommon. A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.

Original languageEnglish
Article numbere5020
JournalMedicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
Volume95
Issue number40
DOIs
Publication statusPublished - 2016

Fingerprint

Cohort Studies
Lamivudine
Prospective Studies
Viral Load
HIV-1
Ritonavir
Confidence Intervals
Viremia
Protease Inhibitors
Atazanavir Sulfate
lamivudine drug combination abacavir
Pharmaceutical Preparations

Keywords

  • Atazanavir
  • HIV-1
  • Protease inhibitors: abacavir
  • Simplification antiretroviral therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression : A prospective cohort study. / Llibre, Josep Maria; Cozzi-Lepri, Alessandro; Pedersen, C.; Ristola, M.; Losso, M.; Mocroft, Amanda; Mitsura, Viktar; Falconer, Karolin; Maltez, F.; Beniowski, M.; Vullo, V.; Hassoun, Gamal; Kuzovatova, Elena; Szlávik, János; Kuznetsova, A.; Stellbrink, H. J.; Duvivier, C.; Edwards, Simon; Laut, Kamilla; Paredes, Roger; Losso, M.; Kundro, M.; Vetter, N.; Zangerle, Robert; Karpov, I.; Vassilenko, A.; Mitsura, V. M.; Paduto, D.; Clumeck, Nathan; De Wit, Stéphane; Delforge, M.; Florence, E.; Vandekerckhove, L.; Hadziosmanovic, V.; Kostov, K.; Begovac, J.; Machala, L.; Jilich, D.; Sedlacek, D.; Kronborg, G.; Benfield, T.; Gerstoft, J.; Katzenstein, T.; Moller, Nina Friis; Pedersen, Court; Ostergaard, L.; Dragsted, Ulrik B.; Nielsen, L. N.; Zilmer, K.; Smidt, J.; Ristola, M.; Aho, I.; Viard, J. P.; Girard, Pierre Marie; Cotte, L.; Pradier, C.; Fontas, Eric; Dabis, F.; Neau, D.; Duvivier, C.; Rockstroh, J.; Schmidt, R. E.; Degen, O.; Stellbrink, H. J.; Stefan, C.; Bogner, J. R.; Fätkenheuer, Gerd; Chkhartishvili, N.; Kosmidis, J.; Gargalianos, P.; Xylomenos, G.; Lourida, P.; Sambatakou, H.; Szlávik, J.; Gottfredsson, M.; Mulcahy, F.; Yust, I.; Turner, D.; Burke, M.; Shahar, E.; Hassoun, G.; Elinav, H.; Haouzi, M.; Elbirt, D.; Sthoeger, Z.; D'Arminio Monforte, A.; Esposito, R.; Mazeu, I.; Mussini, Cristina; Mazzotta, F.; Gabbuti, Andrea; Vullo, Vincenzo; Lichtner, Miriam; Zaccarelli, Mauro; Antinori, A.; Acinapura, R.; Plazzi, M.; Lazzarin, Adriano; Castagna, Antonella; Gianotti, Nicola; Galli, Massimo; Ridolfo, Annalisa; Rozentale, B.; Uzdaviniene, V.; Matulionyte, R.; Staub, T.; Hemmer, R.; Reiss, Peter; Ormaasen, V.; Maeland, A.; Bruun, J.; Knysz, Brygida; Gasiorowski, J.; Inglot, M.; Horban, A.; Bakowska, E.; Flisiak, R.; Grzeszczuk, A.; Parczewski, M.; Pynka, M.; Maciejewska, K.; Beniowski, M.; Mularska, E.; Smiatacz, T.; Gensing, M.; Jablonowska, E.; Malolepsza, E.; Wojcik, K.; Mozer-Lisewska, I.; Doroana, M.; Caldeira, L.; Mansinho, K.; Maltez, F.; Radoi, R.; Oprea, C.; Rakhmanova, A.; Rakhmanova, A.; Trofimora, T.; Khromova, I.; Kuzovatova, E.; Jevtovic, D.; Shunnar, A.; Staneková, D.; Tomazic, J.; Gatell, J. M.; Miro, Jose; Moreno, Santiago; Rodriguez, J. M.; Clotet, Bonaventura; Jou, A.; Paredes, R.; Tural, C.; Puig, J.; Bravo, I.; Domingo, P.; Gutierrez, M.; Mateo, G.; Sambeat, M. A.; Laporte, J. M.; Falconer, K.; Thalme, A.; Sönnerborg, Anders; Blaxhult, A.; Flamholc, L.; Ledergerber, B.; Weber, R.; Cavassini, M.; Calmy, A.; Furrer, Hansjakob; Battegay, Manuel; Schmid, P.; Kravchenko, E.; Frolov, V.; Kutsyna, G.; Baskakov, I.; Kuznetsova, A.; Kyselyova, G.; Sluzhynska, M.; Gazzard, B.; Johnson, Anne M.; Simons, E.; Edwards, S.; Phillips, A. N.; Johnson, Margaret; Mocroft, Amanda; Orkin, C.; Weber, Jonathan; Scullard, G.; Clarke, Amanda; Leen, C.; Lundgren, J. D.; Grarup, Jesper; Thiebaut, Rodolphe; Burger, D. M.; Peters, L.; Matthews, C.; Fischer, Aurelie; Bojesen, A.; Raben, D.; Kristensen, D.; Larsen, J. F.; Podlekareva, D.; Shepherd, L.; Schultze, A.

In: Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries, Vol. 95, No. 40, e5020, 2016.

Research output: Contribution to journalArticle

Llibre, JM, Cozzi-Lepri, A, Pedersen, C, Ristola, M, Losso, M, Mocroft, A, Mitsura, V, Falconer, K, Maltez, F, Beniowski, M, Vullo, V, Hassoun, G, Kuzovatova, E, Szlávik, J, Kuznetsova, A, Stellbrink, HJ, Duvivier, C, Edwards, S, Laut, K, Paredes, R, Losso, M, Kundro, M, Vetter, N, Zangerle, R, Karpov, I, Vassilenko, A, Mitsura, VM, Paduto, D, Clumeck, N, De Wit, S, Delforge, M, Florence, E, Vandekerckhove, L, Hadziosmanovic, V, Kostov, K, Begovac, J, Machala, L, Jilich, D, Sedlacek, D, Kronborg, G, Benfield, T, Gerstoft, J, Katzenstein, T, Moller, NF, Pedersen, C, Ostergaard, L, Dragsted, UB, Nielsen, LN, Zilmer, K, Smidt, J, Ristola, M, Aho, I, Viard, JP, Girard, PM, Cotte, L, Pradier, C, Fontas, E, Dabis, F, Neau, D, Duvivier, C, Rockstroh, J, Schmidt, RE, Degen, O, Stellbrink, HJ, Stefan, C, Bogner, JR, Fätkenheuer, G, Chkhartishvili, N, Kosmidis, J, Gargalianos, P, Xylomenos, G, Lourida, P, Sambatakou, H, Szlávik, J, Gottfredsson, M, Mulcahy, F, Yust, I, Turner, D, Burke, M, Shahar, E, Hassoun, G, Elinav, H, Haouzi, M, Elbirt, D, Sthoeger, Z, D'Arminio Monforte, A, Esposito, R, Mazeu, I, Mussini, C, Mazzotta, F, Gabbuti, A, Vullo, V, Lichtner, M, Zaccarelli, M, Antinori, A, Acinapura, R, Plazzi, M, Lazzarin, A, Castagna, A, Gianotti, N, Galli, M, Ridolfo, A, Rozentale, B, Uzdaviniene, V, Matulionyte, R, Staub, T, Hemmer, R, Reiss, P, Ormaasen, V, Maeland, A, Bruun, J, Knysz, B, Gasiorowski, J, Inglot, M, Horban, A, Bakowska, E, Flisiak, R, Grzeszczuk, A, Parczewski, M, Pynka, M, Maciejewska, K, Beniowski, M, Mularska, E, Smiatacz, T, Gensing, M, Jablonowska, E, Malolepsza, E, Wojcik, K, Mozer-Lisewska, I, Doroana, M, Caldeira, L, Mansinho, K, Maltez, F, Radoi, R, Oprea, C, Rakhmanova, A, Rakhmanova, A, Trofimora, T, Khromova, I, Kuzovatova, E, Jevtovic, D, Shunnar, A, Staneková, D, Tomazic, J, Gatell, JM, Miro, J, Moreno, S, Rodriguez, JM, Clotet, B, Jou, A, Paredes, R, Tural, C, Puig, J, Bravo, I, Domingo, P, Gutierrez, M, Mateo, G, Sambeat, MA, Laporte, JM, Falconer, K, Thalme, A, Sönnerborg, A, Blaxhult, A, Flamholc, L, Ledergerber, B, Weber, R, Cavassini, M, Calmy, A, Furrer, H, Battegay, M, Schmid, P, Kravchenko, E, Frolov, V, Kutsyna, G, Baskakov, I, Kuznetsova, A, Kyselyova, G, Sluzhynska, M, Gazzard, B, Johnson, AM, Simons, E, Edwards, S, Phillips, AN, Johnson, M, Mocroft, A, Orkin, C, Weber, J, Scullard, G, Clarke, A, Leen, C, Lundgren, JD, Grarup, J, Thiebaut, R, Burger, DM, Peters, L, Matthews, C, Fischer, A, Bojesen, A, Raben, D, Kristensen, D, Larsen, JF, Podlekareva, D, Shepherd, L & Schultze, A 2016, 'Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study', Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries, vol. 95, no. 40, e5020. https://doi.org/10.1097/MD.0000000000005020
Llibre, Josep Maria ; Cozzi-Lepri, Alessandro ; Pedersen, C. ; Ristola, M. ; Losso, M. ; Mocroft, Amanda ; Mitsura, Viktar ; Falconer, Karolin ; Maltez, F. ; Beniowski, M. ; Vullo, V. ; Hassoun, Gamal ; Kuzovatova, Elena ; Szlávik, János ; Kuznetsova, A. ; Stellbrink, H. J. ; Duvivier, C. ; Edwards, Simon ; Laut, Kamilla ; Paredes, Roger ; Losso, M. ; Kundro, M. ; Vetter, N. ; Zangerle, Robert ; Karpov, I. ; Vassilenko, A. ; Mitsura, V. M. ; Paduto, D. ; Clumeck, Nathan ; De Wit, Stéphane ; Delforge, M. ; Florence, E. ; Vandekerckhove, L. ; Hadziosmanovic, V. ; Kostov, K. ; Begovac, J. ; Machala, L. ; Jilich, D. ; Sedlacek, D. ; Kronborg, G. ; Benfield, T. ; Gerstoft, J. ; Katzenstein, T. ; Moller, Nina Friis ; Pedersen, Court ; Ostergaard, L. ; Dragsted, Ulrik B. ; Nielsen, L. N. ; Zilmer, K. ; Smidt, J. ; Ristola, M. ; Aho, I. ; Viard, J. P. ; Girard, Pierre Marie ; Cotte, L. ; Pradier, C. ; Fontas, Eric ; Dabis, F. ; Neau, D. ; Duvivier, C. ; Rockstroh, J. ; Schmidt, R. E. ; Degen, O. ; Stellbrink, H. J. ; Stefan, C. ; Bogner, J. R. ; Fätkenheuer, Gerd ; Chkhartishvili, N. ; Kosmidis, J. ; Gargalianos, P. ; Xylomenos, G. ; Lourida, P. ; Sambatakou, H. ; Szlávik, J. ; Gottfredsson, M. ; Mulcahy, F. ; Yust, I. ; Turner, D. ; Burke, M. ; Shahar, E. ; Hassoun, G. ; Elinav, H. ; Haouzi, M. ; Elbirt, D. ; Sthoeger, Z. ; D'Arminio Monforte, A. ; Esposito, R. ; Mazeu, I. ; Mussini, Cristina ; Mazzotta, F. ; Gabbuti, Andrea ; Vullo, Vincenzo ; Lichtner, Miriam ; Zaccarelli, Mauro ; Antinori, A. ; Acinapura, R. ; Plazzi, M. ; Lazzarin, Adriano ; Castagna, Antonella ; Gianotti, Nicola ; Galli, Massimo ; Ridolfo, Annalisa ; Rozentale, B. ; Uzdaviniene, V. ; Matulionyte, R. ; Staub, T. ; Hemmer, R. ; Reiss, Peter ; Ormaasen, V. ; Maeland, A. ; Bruun, J. ; Knysz, Brygida ; Gasiorowski, J. ; Inglot, M. ; Horban, A. ; Bakowska, E. ; Flisiak, R. ; Grzeszczuk, A. ; Parczewski, M. ; Pynka, M. ; Maciejewska, K. ; Beniowski, M. ; Mularska, E. ; Smiatacz, T. ; Gensing, M. ; Jablonowska, E. ; Malolepsza, E. ; Wojcik, K. ; Mozer-Lisewska, I. ; Doroana, M. ; Caldeira, L. ; Mansinho, K. ; Maltez, F. ; Radoi, R. ; Oprea, C. ; Rakhmanova, A. ; Rakhmanova, A. ; Trofimora, T. ; Khromova, I. ; Kuzovatova, E. ; Jevtovic, D. ; Shunnar, A. ; Staneková, D. ; Tomazic, J. ; Gatell, J. M. ; Miro, Jose ; Moreno, Santiago ; Rodriguez, J. M. ; Clotet, Bonaventura ; Jou, A. ; Paredes, R. ; Tural, C. ; Puig, J. ; Bravo, I. ; Domingo, P. ; Gutierrez, M. ; Mateo, G. ; Sambeat, M. A. ; Laporte, J. M. ; Falconer, K. ; Thalme, A. ; Sönnerborg, Anders ; Blaxhult, A. ; Flamholc, L. ; Ledergerber, B. ; Weber, R. ; Cavassini, M. ; Calmy, A. ; Furrer, Hansjakob ; Battegay, Manuel ; Schmid, P. ; Kravchenko, E. ; Frolov, V. ; Kutsyna, G. ; Baskakov, I. ; Kuznetsova, A. ; Kyselyova, G. ; Sluzhynska, M. ; Gazzard, B. ; Johnson, Anne M. ; Simons, E. ; Edwards, S. ; Phillips, A. N. ; Johnson, Margaret ; Mocroft, Amanda ; Orkin, C. ; Weber, Jonathan ; Scullard, G. ; Clarke, Amanda ; Leen, C. ; Lundgren, J. D. ; Grarup, Jesper ; Thiebaut, Rodolphe ; Burger, D. M. ; Peters, L. ; Matthews, C. ; Fischer, Aurelie ; Bojesen, A. ; Raben, D. ; Kristensen, D. ; Larsen, J. F. ; Podlekareva, D. ; Shepherd, L. ; Schultze, A. / Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression : A prospective cohort study. In: Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries. 2016 ; Vol. 95, No. 40.
@article{3eab4a8aaf9d46f0927e4c80b8347776,
title = "Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study",
abstract = "Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant. We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50copies/mL. We included 285 subjects, 67{\%} male, with median baseline CD4 530 cells, and 44 months with pVL ≤50copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28{\%}), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10{\%}). Ninety (32{\%}) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90{\%}/87{\%}/88{\%} (TLOVR) and 74{\%}/67{\%}/59{\%} (snapshot analysis), respectively. The rates of VF were 8{\%}/8{\%}/6{\%}. Rates of adverse events leading to study discontinuation were 0.4{\%}/1{\%}/2{\%}. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95{\%} confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50copies/mL (HR 0.87 [95{\%} CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95{\%} CI: 1.28-6.04]). Resistance selection at failure was uncommon. A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.",
keywords = "Atazanavir, HIV-1, Protease inhibitors: abacavir, Simplification antiretroviral therapy",
author = "Llibre, {Josep Maria} and Alessandro Cozzi-Lepri and C. Pedersen and M. Ristola and M. Losso and Amanda Mocroft and Viktar Mitsura and Karolin Falconer and F. Maltez and M. Beniowski and V. Vullo and Gamal Hassoun and Elena Kuzovatova and J{\'a}nos Szl{\'a}vik and A. Kuznetsova and Stellbrink, {H. J.} and C. Duvivier and Simon Edwards and Kamilla Laut and Roger Paredes and M. Losso and M. Kundro and N. Vetter and Robert Zangerle and I. Karpov and A. Vassilenko and Mitsura, {V. M.} and D. Paduto and Nathan Clumeck and {De Wit}, St{\'e}phane and M. Delforge and E. Florence and L. Vandekerckhove and V. Hadziosmanovic and K. Kostov and J. Begovac and L. Machala and D. Jilich and D. Sedlacek and G. Kronborg and T. Benfield and J. Gerstoft and T. Katzenstein and Moller, {Nina Friis} and Court Pedersen and L. Ostergaard and Dragsted, {Ulrik B.} and Nielsen, {L. N.} and K. Zilmer and J. Smidt and M. Ristola and I. Aho and Viard, {J. P.} and Girard, {Pierre Marie} and L. Cotte and C. Pradier and Eric Fontas and F. Dabis and D. Neau and C. Duvivier and J. Rockstroh and Schmidt, {R. E.} and O. Degen and Stellbrink, {H. J.} and C. Stefan and Bogner, {J. R.} and Gerd F{\"a}tkenheuer and N. Chkhartishvili and J. Kosmidis and P. Gargalianos and G. Xylomenos and P. Lourida and H. Sambatakou and J. Szl{\'a}vik and M. Gottfredsson and F. Mulcahy and I. Yust and D. Turner and M. Burke and E. Shahar and G. Hassoun and H. Elinav and M. Haouzi and D. Elbirt and Z. Sthoeger and {D'Arminio Monforte}, A. and R. Esposito and I. Mazeu and Cristina Mussini and F. Mazzotta and Andrea Gabbuti and Vincenzo Vullo and Miriam Lichtner and Mauro Zaccarelli and A. Antinori and R. Acinapura and M. Plazzi and Adriano Lazzarin and Antonella Castagna and Nicola Gianotti and Massimo Galli and Annalisa Ridolfo and B. Rozentale and V. Uzdaviniene and R. Matulionyte and T. Staub and R. Hemmer and Peter Reiss and V. Ormaasen and A. Maeland and J. Bruun and Brygida Knysz and J. Gasiorowski and M. Inglot and A. Horban and E. Bakowska and R. Flisiak and A. Grzeszczuk and M. Parczewski and M. Pynka and K. Maciejewska and M. Beniowski and E. Mularska and T. Smiatacz and M. Gensing and E. Jablonowska and E. Malolepsza and K. Wojcik and I. Mozer-Lisewska and M. Doroana and L. Caldeira and K. Mansinho and F. Maltez and R. Radoi and C. Oprea and A. Rakhmanova and A. Rakhmanova and T. Trofimora and I. Khromova and E. Kuzovatova and D. Jevtovic and A. Shunnar and D. Stanekov{\'a} and J. Tomazic and Gatell, {J. M.} and Jose Miro and Santiago Moreno and Rodriguez, {J. M.} and Bonaventura Clotet and A. Jou and R. Paredes and C. Tural and J. Puig and I. Bravo and P. Domingo and M. Gutierrez and G. Mateo and Sambeat, {M. A.} and Laporte, {J. M.} and K. Falconer and A. Thalme and Anders S{\"o}nnerborg and A. Blaxhult and L. Flamholc and B. Ledergerber and R. Weber and M. Cavassini and A. Calmy and Hansjakob Furrer and Manuel Battegay and P. Schmid and E. Kravchenko and V. Frolov and G. Kutsyna and I. Baskakov and A. Kuznetsova and G. Kyselyova and M. Sluzhynska and B. Gazzard and Johnson, {Anne M.} and E. Simons and S. Edwards and Phillips, {A. N.} and Margaret Johnson and Amanda Mocroft and C. Orkin and Jonathan Weber and G. Scullard and Amanda Clarke and C. Leen and Lundgren, {J. D.} and Jesper Grarup and Rodolphe Thiebaut and Burger, {D. M.} and L. Peters and C. Matthews and Aurelie Fischer and A. Bojesen and D. Raben and D. Kristensen and Larsen, {J. F.} and D. Podlekareva and L. Shepherd and A. Schultze",
year = "2016",
doi = "10.1097/MD.0000000000005020",
language = "English",
volume = "95",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "40",

}

TY - JOUR

T1 - Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression

T2 - A prospective cohort study

AU - Llibre, Josep Maria

AU - Cozzi-Lepri, Alessandro

AU - Pedersen, C.

AU - Ristola, M.

AU - Losso, M.

AU - Mocroft, Amanda

AU - Mitsura, Viktar

AU - Falconer, Karolin

AU - Maltez, F.

AU - Beniowski, M.

AU - Vullo, V.

AU - Hassoun, Gamal

AU - Kuzovatova, Elena

AU - Szlávik, János

AU - Kuznetsova, A.

AU - Stellbrink, H. J.

AU - Duvivier, C.

AU - Edwards, Simon

AU - Laut, Kamilla

AU - Paredes, Roger

AU - Losso, M.

AU - Kundro, M.

AU - Vetter, N.

AU - Zangerle, Robert

AU - Karpov, I.

AU - Vassilenko, A.

AU - Mitsura, V. M.

AU - Paduto, D.

AU - Clumeck, Nathan

AU - De Wit, Stéphane

AU - Delforge, M.

AU - Florence, E.

AU - Vandekerckhove, L.

AU - Hadziosmanovic, V.

AU - Kostov, K.

AU - Begovac, J.

AU - Machala, L.

AU - Jilich, D.

AU - Sedlacek, D.

AU - Kronborg, G.

AU - Benfield, T.

AU - Gerstoft, J.

AU - Katzenstein, T.

AU - Moller, Nina Friis

AU - Pedersen, Court

AU - Ostergaard, L.

AU - Dragsted, Ulrik B.

AU - Nielsen, L. N.

AU - Zilmer, K.

AU - Smidt, J.

AU - Ristola, M.

AU - Aho, I.

AU - Viard, J. P.

AU - Girard, Pierre Marie

AU - Cotte, L.

AU - Pradier, C.

AU - Fontas, Eric

AU - Dabis, F.

AU - Neau, D.

AU - Duvivier, C.

AU - Rockstroh, J.

AU - Schmidt, R. E.

AU - Degen, O.

AU - Stellbrink, H. J.

AU - Stefan, C.

AU - Bogner, J. R.

AU - Fätkenheuer, Gerd

AU - Chkhartishvili, N.

AU - Kosmidis, J.

AU - Gargalianos, P.

AU - Xylomenos, G.

AU - Lourida, P.

AU - Sambatakou, H.

AU - Szlávik, J.

AU - Gottfredsson, M.

AU - Mulcahy, F.

AU - Yust, I.

AU - Turner, D.

AU - Burke, M.

AU - Shahar, E.

AU - Hassoun, G.

AU - Elinav, H.

AU - Haouzi, M.

AU - Elbirt, D.

AU - Sthoeger, Z.

AU - D'Arminio Monforte, A.

AU - Esposito, R.

AU - Mazeu, I.

AU - Mussini, Cristina

AU - Mazzotta, F.

AU - Gabbuti, Andrea

AU - Vullo, Vincenzo

AU - Lichtner, Miriam

AU - Zaccarelli, Mauro

AU - Antinori, A.

AU - Acinapura, R.

AU - Plazzi, M.

AU - Lazzarin, Adriano

AU - Castagna, Antonella

AU - Gianotti, Nicola

AU - Galli, Massimo

AU - Ridolfo, Annalisa

AU - Rozentale, B.

AU - Uzdaviniene, V.

AU - Matulionyte, R.

AU - Staub, T.

AU - Hemmer, R.

AU - Reiss, Peter

AU - Ormaasen, V.

AU - Maeland, A.

AU - Bruun, J.

AU - Knysz, Brygida

AU - Gasiorowski, J.

AU - Inglot, M.

AU - Horban, A.

AU - Bakowska, E.

AU - Flisiak, R.

AU - Grzeszczuk, A.

AU - Parczewski, M.

AU - Pynka, M.

AU - Maciejewska, K.

AU - Beniowski, M.

AU - Mularska, E.

AU - Smiatacz, T.

AU - Gensing, M.

AU - Jablonowska, E.

AU - Malolepsza, E.

AU - Wojcik, K.

AU - Mozer-Lisewska, I.

AU - Doroana, M.

AU - Caldeira, L.

AU - Mansinho, K.

AU - Maltez, F.

AU - Radoi, R.

AU - Oprea, C.

AU - Rakhmanova, A.

AU - Rakhmanova, A.

AU - Trofimora, T.

AU - Khromova, I.

AU - Kuzovatova, E.

AU - Jevtovic, D.

AU - Shunnar, A.

AU - Staneková, D.

AU - Tomazic, J.

AU - Gatell, J. M.

AU - Miro, Jose

AU - Moreno, Santiago

AU - Rodriguez, J. M.

AU - Clotet, Bonaventura

AU - Jou, A.

AU - Paredes, R.

AU - Tural, C.

AU - Puig, J.

AU - Bravo, I.

AU - Domingo, P.

AU - Gutierrez, M.

AU - Mateo, G.

AU - Sambeat, M. A.

AU - Laporte, J. M.

AU - Falconer, K.

AU - Thalme, A.

AU - Sönnerborg, Anders

AU - Blaxhult, A.

AU - Flamholc, L.

AU - Ledergerber, B.

AU - Weber, R.

AU - Cavassini, M.

AU - Calmy, A.

AU - Furrer, Hansjakob

AU - Battegay, Manuel

AU - Schmid, P.

AU - Kravchenko, E.

AU - Frolov, V.

AU - Kutsyna, G.

AU - Baskakov, I.

AU - Kuznetsova, A.

AU - Kyselyova, G.

AU - Sluzhynska, M.

AU - Gazzard, B.

AU - Johnson, Anne M.

AU - Simons, E.

AU - Edwards, S.

AU - Phillips, A. N.

AU - Johnson, Margaret

AU - Mocroft, Amanda

AU - Orkin, C.

AU - Weber, Jonathan

AU - Scullard, G.

AU - Clarke, Amanda

AU - Leen, C.

AU - Lundgren, J. D.

AU - Grarup, Jesper

AU - Thiebaut, Rodolphe

AU - Burger, D. M.

AU - Peters, L.

AU - Matthews, C.

AU - Fischer, Aurelie

AU - Bojesen, A.

AU - Raben, D.

AU - Kristensen, D.

AU - Larsen, J. F.

AU - Podlekareva, D.

AU - Shepherd, L.

AU - Schultze, A.

PY - 2016

Y1 - 2016

N2 - Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant. We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50copies/mL. We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28%), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10%). Ninety (32%) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90%/87%/88% (TLOVR) and 74%/67%/59% (snapshot analysis), respectively. The rates of VF were 8%/8%/6%. Rates of adverse events leading to study discontinuation were 0.4%/1%/2%. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95% confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50copies/mL (HR 0.87 [95% CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95% CI: 1.28-6.04]). Resistance selection at failure was uncommon. A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.

AB - Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant. We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50copies/mL. We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28%), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10%). Ninety (32%) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90%/87%/88% (TLOVR) and 74%/67%/59% (snapshot analysis), respectively. The rates of VF were 8%/8%/6%. Rates of adverse events leading to study discontinuation were 0.4%/1%/2%. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95% confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50copies/mL (HR 0.87 [95% CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95% CI: 1.28-6.04]). Resistance selection at failure was uncommon. A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.

KW - Atazanavir

KW - HIV-1

KW - Protease inhibitors: abacavir

KW - Simplification antiretroviral therapy

UR - http://www.scopus.com/inward/record.url?scp=84995686661&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84995686661&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000005020

DO - 10.1097/MD.0000000000005020

M3 - Article

VL - 95

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 40

M1 - e5020

ER -