title: Cardiovascular risk score change in HIV-1-infected patients switched to an atazanavir-based combination antiretroviral regimen.
abstract: BACKGROUND
  We aimed to establish whether the limited impact of atazanavir on the plasma lipid profile could translate into a reduction in the predicted cardiovascular risk in antiretroviral (ARV)-experienced patients switching to an atazanavir-containing regimen.
  
  
  METHODS
  HIV-1-infected treatment-experienced patients, switched to atazanavir for whatever reason and without prior major cardiovascular events, were selected and followed for at least 1 month. An individual cardiovascular risk score (10-year risk of major cardiovascular events) based on validated events and measurable risk factors in Italian cardiovascular cohorts was calculated using software available online.
  
  
  RESULTS
  A total of 197 patients were selected for inclusion in the study. After switching to atazanavir, the mean changes from pre-switch to last available measurement were -6.5% (P<0.001) for total cholesterol, -1.7% (P=0.029) for high-density lipoprotein (HDL) cholesterol, -11.3% (P<0.001) for non-HDL cholesterol and -8.6% (P<0.001) for triglycerides. The crude cardiovascular risk score was reduced from 3.43 to 3.38% (P=0.51); the analysis normalized by age showed a reduction from 3.43 to 3.14% (P<0.001). Subsets of patients with high baseline total cholesterol or triglycerides showed more marked reductions.
  
  
  CONCLUSIONS
  A treatment switch to atazanavir caused significant reductions in plasma lipids and a modest but significant reduction in the normalized-for-age cardiovascular risk score. Efforts should be made to concomitantly reduce the other preventable cardiovascular risk factors.
authors.affiliation: Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy. manuela76@inwind.it
authors.forename: M
authors.initials: M
authors.lastname: Colafigli
authors.forename: S
authors.initials: S
authors.lastname: Di Giambenedetto
authors.forename: L
authors.initials: L
authors.lastname: Bracciale
authors.forename: E
authors.initials: E
authors.lastname: Tamburrini
authors.forename: R
authors.initials: R
authors.lastname: Cauda
authors.forename: A
authors.initials: A
authors.lastname: De Luca
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D000069446:Atazanavir Sulfate; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D015497:HIV-1; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D050356:Lipid Metabolism / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects*; D011725:Pyridines / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D017320:HIV Protease Inhibitors; D000960:Hypolipidemic Agents; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate