Efficacy and safety of unboosted atazanavir in combination with lamivudine and didanosine in naive HIV type 1 patients in Senegal.

The use of ritonavir as a protease inhibitor boost is rare in sub-Saharan Africa because a heat-stable formula is not available. We report the results of an open-label pilot trial with unboosted atazanavir in combination with lamivudine and didanosine as first-line therapy conducted in Senegal. Treatment-naive HIV-1 infected adult patients without active opportunistic disease were included. The primary endpoint was the proportion of patients with plasma HIV-1 RNA <400 copies/ml at week 48. Forty patients (12 men and 28 women; mean age +/- SD: 40 +/- 9 years) were included. Treatment was changed during the study for two patients (pregnancy, tuberculosis); one patient was lost to follow-up and one patient died (gastroenteritis with cachexia). At week 48, 78% [95% confidence interval (CI): 65-90%] and 68% (95% CI: 53-82%) of the patients had HIV-1 RNA <400 and <50 copies/ml, respectively (intent-to-treat analysis; not completer = failure). Among the seven patients with HIV-1 RNA >or=400 copies/ml at week 48, five were not compliant; genotyping analysis (n = 4) did not reveal a major mutation for protease inhibitors. The mean CD4 cell count change from baseline to week 48 was +238 +/- 79 cells/mm(3). The combination of unboosted atazanavir with lamivudine and didanosine was efficient and well tolerated in HIV-1-infected patients with results similar to those observed in Northern countries. These results suggest that unboosted atazanavir with its high genetic barrier could be a valuable alternative to NNRTIs in resource-limited countries in some HIV-1-infected patients in case of compliance issues with NNRTIs, intolerance to NNRTIs, resistance mutations to NNRTIs, in women with childbearing potential, or as a maintenance therapy in patients with virological suppression.

[Efficacy and tolerance of antiretroviral therapy in HIV-2 infected patients in Dakar: preliminary study]. / Evaluation de l'efficacité et de la tolérance du traitement antirétroviral chez des patients infectés par le VIH-2 à Dakar: étude préliminaire.

OBJECTIVE: The authors had for aim to evaluate the clinical and immunological response as well as the tolerance to antiretroviral therapy in HIV-2 infected patients. DESIGN: A retrospective chart review was made from August 1998 to August 2004. RESULTS: 188 patients were on protease inhibitor based regimen. 153 (81.38%) were HIV-1 and 35 (18.62%) HIV-2 infected patients. The mean weight gain was significantly higher in the HIV-2 group at months 9 and 12 (P=0.02 et P=0.01 respectively), whereas CD4 cells count gain was higher in the HIV-1 group at month 6 (P=0.004). New AIDS defining criteria are less likely to occur in HIV-2 infected patients on HAART than in HIV-1 (P=0.004). Lipodystrophy syndrome was present only in HIV-1 infected patients. CONCLUSION: Antiretroviral therapy in HIV-2 infected patients shows similar clinical and immunological efficacy than in HIV-1 infected ones and is also well tolerated.