Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression
Llibre, Josep M. (Institut Germans Trias i Pujol. Fundació Lluita Contra les Infeccions)
Cozzi-Lepri, Alessandro (University College London, UK)
Pedersen, Court (Odense University Hospital (Dinamarca))
Ristola, Matti (Helsinki University Hospital (Finlàndia))
Losso, Marcelo (Hospital General de Agudos JM Ramos Mejía, Buenos Aires, Argentina)
Mocroft, Amanda (University College London, UK)
Mitsura, Viktar (Gomel State Medical University, Belarus)
Falconer, Karolin (Karolinska University Hospital and Karolinska Institutet (Suècia))
Maltez, Fernando (Curry Cabral Hospital, Lisboa, Portugal)
Beniowski, Marek (Specialistic Hospital, Chorzów, Poland)
Vullo, Vincenzo (Policlinico Umberto 1, Rome, Italy)
Hassoun, Gamal (Rambam-Health Care Campus, Haifa, Israel)
Kuzovatova, Elena (Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Russia)
Szlavik, János (St László Hospital (Hongria))
Kuznetsova, Anastasiia (Kharkov State Medical University, Ukraine)
Stellbrink, Hans-Jürgen (ICH Study Center, Hamburg, Germany)
Duvivier, Claudine (APHP-Hôpital Necker-Enfants Malades, Paris, France)
Edwards, Simon (Mortimer Market Centre, UK)
Laut, Kamilla (Centre for Health & University of Copenhagen, Denmark)
Paredes, Roger (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)

Data:	2016
Resum:	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 <50 copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50 copies/mL. We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50 copies/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 ≤50 copies/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.
Ajuts:	European Commission 260694
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució i la comunicació pública de l'obra, sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atazanavir ; HIV-1 ; Protease inhibitors: abacavir ; Simplification antiretroviral therapy
Publicat a:	Medicine, Vol. 95, Num. 40 (october 2016) , ISSN 1536-5964

DOI: 10.1097/MD.0000000000005020
PMID: 27749561

7 p, 214.7 KB

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