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| |  Simplified HIV Regimen Without Ritonavir Effective in HIV Patients With Suppressed Viral Loads: Presented at IAS By Charlene Laino CAPE TOWN, South Africa -- July 23, 2009 -- For patients whose viral load is suppressed on their first antiretroviral regimen, the regimen can be simplified by dropping the ritonavir, according to the randomised stage of a 2-stage trial presented here at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention. Of the patients who did not receive ritonavir, 86% had undetectable viral loads of <50 copies/mL after 84 weeks of treatment, compared with 81% of those that received ritonavir (P = .14), according to Kathleen E. Squires, MD, Division of Infectious Diseases and Environmental Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Squires reported the findings on July 22 at a late-breaking session. Many clinicians do not like to prescribe ritonavir because of toxicity and drug-drug interactions, she said. In this study, treatment-naïve patients were given atazanavir, boosted with ritonavir, in combination with abacavir and lamivudine for 36 weeks. The 419 patients whose viral load was undetectable at the end of that period were randomised to continue boosted atazanavir 300 mg daily or to get a slightly higher dose of atazanavir 400 mg daily but without ritonavir. All patients continued on abacavir and lamivudine. By 84 weeks, the CD4 cell count increased 259 cells/mm3 in the 210-patient arm not receiving ritonavir, compared with 240 cells/mm3 in the 209-patient ritonavir arm, which was not significantly different. Patients who were no longer taking ritonavir had a slightly better lipid profile, she said. Cholesterol dropped a median of 14 mg/dL in the no-ritonavir arm versus a gain of 6 mg/dL in the ritonavir arm. Triglycerides fell 34 mg/dL and 4 mg/dL in the no-ritonavir and ritonavir arms, respectively. Ten percent of patients in the no-ritonavir arm reported grade 2 to 4 adverse events during the randomisation phase, compared with 14% of those in the boosted atazanavir arm. The most common event was hyperbilirubinaemia, reported by 4% and 10% of patients in the no-ritonavir and ritonavir arms, respectively, during the randomisation phase. Funding for this study was provided by GlaxoSmithKline. [Presentation title: Similar Efficacy and Tolerability of Atazanavir (ATV) Compared to ATV/Ritonavir (RTV, r), Each in Combination With Abacavir/Lamivudine (ABC/3TC), After Initial Suppression With ABC/3TC + ATV/r in HIV-1 Infected Patients: 84 Week Results of the ARIES Trial. Abstract WELBB103]
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