Switching to unboosted atazanavir improves glucose tolerance in highly pretreated HIV-1 infected subjects.
OBJECTIVE
To evaluate the 24-week effects on glucose tolerance of switching from a protease inhibitor (PI)-based to an unboosted atazanavir-including regimen in highly pretreated HIV-1 infected subjects with metabolic alterations.


METHODS
Prospective, open-label, single-center, 24-week pilot study.


METHODS
Twenty-one subjects underwent an oral glucose tolerance test (OGTT) at baseline (BL) and after 24 weeks of unboosted atazanavir. Insulin sensitivity and beta-cell responsiveness were evaluated on the basis of static and dynamic data; fasting glucose, insulin, C-peptide, triglycerides (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), TC/HDL-c ratio, CD4+ cell count and HIV-1 RNA were measured.


RESULTS
After 24 weeks of unboosted atazanavir, the 120-min glucose level was significantly lower than the one measured at BL (P=0.021); there were no statistically significant differences in the insulin concentration profile. The SI(oral), an OGTT-based index of insulin sensitivity, was significantly higher at week 24 (P=0.017); the indices of first- and second-phase beta-cell responsiveness did not significantly change. There was no significant difference between BL and 24-week fasting glucose, insulin or C-peptide levels, and consequently no change in fasting homeostasis model assessment indices of insulin sensitivity and beta-cell function. There were significant improvements in TG (P=0.009), TC (P=0.0001), LDL-c (P=0.019) and TC/HDL-c ratio (P=0.001), and a similar trend in HDL-c levels (P=0.069). No significant changes in the immunological and virological parameters were detected.


CONCLUSIONS
Our results show that switching from a PI-based to an unboosted atazanavir-including regimen leads to a significant improvement in glucose tolerance in highly pretreated HIV-1 infected subjects with metabolic alterations.
Guffanti
Monica
M
Clinic of Infectious Diseases, San Raffaele Scientific Institute, Via Stamira d'ancona 20, 20127 Milan, Italy. guffanti.monica@hsr.it
Caumo
Andrea
A
Galli
Laura
L
Bigoloni
Alba
A
Galli
Andrea
A
Dagba
Geneviéve
G
Danise
Anna
A
Luzi
Livio
L
Lazzarin
Adriano
A
Castagna
Antonella
A
D000328:Adult; D000069446:Atazanavir Sulfate; D001786:Blood Glucose / Q000378:metabolism*; D005215:Fasting / Q000097:blood / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1; D006801:Humans; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D019233:Retreatment; D016896:Treatment Outcome
D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011480:Protease Inhibitors; D011725:Pyridines; D000069446:Atazanavir Sulfate