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| |  Unboosted Atazanavir Maintains Virological Control in Long-Term HIV Treatment: Presented at AIDS 2010 By Evelyn Harvey VIENNA -- July 23, 2010 -- The daily use of unboosted atazanavir (ATV) in antiretroviral therapy (ART) avoids ritonavir-related adverse effects and does not lead to increased virological failure in treatment-experienced patients with HIV, researchers said here at the 18th International AIDS Conference. The results were presented on July 22 by Jean-Michel Molina, MD, Hôpital Saint-Louis, Paris, France, as part of the European AIDS Treatment Network (NEAT) initiative. The researchers examined data from 899 patients with HIV who switched to unboosted atazanavir regimens plus nucleoside reverse transcriptase inhibitors (NRTIs) between January 2002 and December 2008. All patients had HIV RNA viral loads <50 copies/mL following prior ARV treatment. The main reasons for switching were simplification (46%) and adverse events (28.5%). The NRTIs used were tenofovir (33.8%), abacavir (43.9%), and emtricitabine/lamivudine (94.2%). Atazanavir was dosed 400 mg once daily in 97.6% of patients. Median CD4 cell count was 488 cells/mm3, and 35.5% were coinfected with hepatitis C (HCV). Median follow-up was 21 months. Time to virological failure and time to treatment discontinuation were examined. The probability of virological rebound over 3 years was 19.9% overall. However, among the 436 patients without a history of virological failure on prior regimens, the 3-year probability of virological failure was lower, at 11%. A history of virological failure under NRTIs (P = .005) or a protease inhibitor (PI; P = .05) was significantly associated with the risk of virological failure on the unboosted atazanavir regimen. HCV coinfection (P = .016) and abacavir use (P = .038), but not tenofovir use, were also associated with the risk of virological failure. During follow-up 17 patients (1.9%) died, 15 (1.7%) experienced an AIDS-defining event (3 cardiovascular events), 14 (1.5%) developed liver cirrhosis, 20 (2.2%) diabetes, and 7 (0.8%) nephrolithiasis. "In this cohort of well-suppressed patients, a switch to unboosted atazanavir was associated with a low probability of virological failure, especially among those without a history of previous virological failure, and an acceptable safety profile," concluded the authors. However, this analysis suggests that switching to an unboosted atazanavir regimen could be less advisable in patients with HCV coinfection, or with previous history of virological failure on NRTIs or PIs, unless there are very strong reasons for switching such as serious adverse events. [Presentation title: Long-Term Efficacy and Safety of a Switch to Unboosted Atazanavir (ATV) in Well Controlled HIV-1 Infected Patients, Results of the NEAT Unboosted Atazanavir Cohort. Abstract THPE0125]
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