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 journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

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