Baseline lipid levels rather than the presence of reported body shape changes determine the degree of improvement in lipid levels after switching to atazanavir.
OBJECTIVE
To study factors influencing lipid changes after switching to atazanavir (ATV) and the effectiveness of ATV in maintaining virus suppression.


METHODS
Retrospective cohort study in patients with viral suppression, comparing patients switching to ATV with those continuing combination antiretroviral therapy (cART). Outcome measures were 48-week total (TC), high-density (HDL) and low-density lipoprotein (LDL) cholesterol, and triglycerides (TG) changes, stratified for dyslipidemia and lipodystrophy and virological failure (time to first of two consecutive detectable HIV RNA).


RESULTS
225 patients switched to ATV (193 [85.8%] RTV boosted), and 3120 continued cART. In patients with baseline TC >6.2 mmol/L, those switching had greater mean (95% CI) TC decreases compared to those continuing cART (-1.26 [-1.63 to -0.89] and -0.54 [-0.64 to -0.44] mmol/L, p = .002). Likewise greater TG changes were observed in patients with high (>2.3 mmol/L) baseline TG (-1.44 [-2.05 to -0.83] and -0.54 [-0.70 to -0.38] mmol/L, p = .002). Effects were seen irrespective of presence of lipodystrophy. Patients switching to ATV had virological failure more often (17/224 [7.8%]) than those continuing cART (73/3100 [2.4%], p < .0001).


CONCLUSIONS
Patients with virological suppression, including those with lipodystrophy, may benefit from switching to ATV with lipid profile improvement, especially if baseline lipid levels are high. This should be balanced against a possible higher virological failure risk.
van Vonderen
M G A
MG
Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands. M.van.Vonderen@znb.nl
Gras
L
L
Wit
F
F
Brinkman
K
K
van der Ende
M E
ME
Hoepelman
A I M
AI
de Wolf
F
F
Reiss
P
P
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D000069446:Atazanavir Sulfate; D015992:Body Mass Index; D049628:Body Size; D015331:Cohort Studies; D050171:Dyslipidemias / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009842:Oligopeptides / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D012044:Regression Analysis; D012189:Retrospective Studies; D019562:Viral Load
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D008055:Lipids; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate