Efficacy and safety of treatment simplification to atazanavir/ritonavirâ+âlamivudine in HIV-infected patients with virological suppression: 144 week follow-up of the AtLaS pilot study.
J Antimicrob Chemother
; 70(6): 1843-9, 2015.
Article
en En
| MEDLINE
| ID: mdl-25885326
ABSTRACT
OBJECTIVES:
AtLaS was a single-arm pilot study that demonstrated promising efficacy and safety of treatment simplification to a dual regimen with atazanavir/ritonavirâ+âlamivudine in virologically suppressed HIV-positive patients. Here, we report data from the 144 week follow-up.METHODS:
At baseline, patients treated with a three-drug atazanavir/ritonavir-based regimen were switched to 300/100 mg of atazanavir/ritonavir plus 300 mg of lamivudine once daily. Major clinical events, laboratory parameters, neurocognitive performance, bone composition and body fat distribution were monitored. Treatment failure was defined as a discontinuation/switch of the regimen or virological failure (HIV-RNA >50 copies/mL in two consecutive determinations or a single level above 1000 copies/mL).RESULTS:
After 144 weeks, 9/40 (22.5%) treatment failures occurred, including two virological failures (Weeks 48 and 53, without resistance). A significant increase in the CD4 count was observed at Week 96 (+124 cells/mm(3); Pâ=â0.002) and Week 144 (+94 cells/mm(3); Pâ=â0.008). After 144 weeks, a significant increase in total cholesterol (+25 mg/dL; Pâ=â0.001), HDL cholesterol (+6 mg/dL; Pâ=â0.024) and LDL cholesterol (+12 mg/dL; Pâ=â0.008) was observed, without any change in triglyceride levels, total cholesterol/HDL ratio or LDL/HDL ratio. A significant increase in the estimated glomerular filtration rate (+25 mL/min/1.73 m(2); Pâ<â0.001) and lumbar spine T-score and Z-score (+0.2, Pâ=â0.011; and +0.35, Pâ=â0.001, respectively) and a decrease in trunk fat (-1.898 g; Pâ=â0.005) were also observed. Neurocognitive function did not decline over time. Concerning safety, 10 moderate to severe adverse events were recorded in eight patients; overall seven cases of renal colic (possibly treatment related) were observed, leading to a discontinuation of treatment in two patients.CONCLUSIONS:
Data from the 144 week follow-up suggested good long-term efficacy of the simplification strategy that was investigated, with rare virological failure and a potential for improvement of the CD4 count, renal function and bone mineral density. This strategy warrants further investigation in a randomized trial.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
/
Ritonavir
/
Lamivudine
/
Fármacos Anti-VIH
/
Terapia Antirretroviral Altamente Activa
/
Sulfato de Atazanavir
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Antimicrob Chemother
Año:
2015
Tipo del documento:
Article
País de afiliación:
Italia