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Atazanavir/Ritonavir as Effective as Lopinavir/Ritonavir in HIV Treatment-Naive Patients NEW YORK -- August 1, 2008 -- In HIV treatment-naïve patients, atazanavir/ritonavir (A/R) QD shows similar antiviral efficacy to lopinavir/ritonavir (L/R) BID, according to a study published early online in the August 2 edition of The Lancet. The authors of the CASTLE study recommend that once-daily A/R should be a first-line treatment option for these patients as it has a number of advantages over the currently recommended twice-daily L/R. Professor Jean-Michel Molina, Hopital Saint-Louis, Paris, France; Graeme Moyle, MD, Chelsea and Westminster Hospital, London, United Kingdom; and colleagues did a study of 883 antiretroviral-naïve, HIV infected patients. Patients were randomised to receive A/R 300/100 mg QD (n = 440) or L/R 400/100 mg BID (n = 443). Both regimens were in combination with tenofovir/emtricitabine 300/200 mg QD. The percentage of patients with viral load <50 copies/mL was measured at 48 weeks. The researchers found that 78% of patients receiving A/R and 76% of those receiving L/R had achieved the target viral load <50 copies/mL by week 48. CD4 cell counts increased by 203 cells/mcL in the A/R group and by 219 cells/mcL in the L/R group. In both groups, 6% of patients experienced treatment failure by the end of the study; 2 patients developed resistance mutations to treatment in the A/R group compared with none in the L/R group. Serious adverse events occurred in 12% of A/R patients and 10% of L/R patients. However, fewer patients in the A/R group compared with the L/R group experienced treatment-related diarrhoea (2% vs 11%) and nausea (4% vs 8%). Jaundice was seen in 4% of patients in the A/R group, while none was observed in the L/R group. Increases in bilirubin were seen in 34% of patients in the A/R group but in less than 1% of patients in the L/R group. "In treatment-naïve patients, atazanavir/ritonavir once-daily demonstrated similar antiviral efficacy to lopinavir/ritonavir twice daily, with less gastrointestinal toxicity but with a higher rate of hyperbilirubinaemia," the authors wrote. The authors added that the results of this study support the use of once-daily A/R as a recommended first-line treatment option, with a number of patient benefits over the currently recommended ritonavir-boosted twice-daily lopinavir for the treatment of HIV-infected antiretroviral-naïve patients. SOURCE: The Lancet E-mail this page to a friend or colleague! To print, use this version