[Clinical utility of atazanavir].
Atazanavir (ATV) is a protease inhibitor (PI) in which its main qualities, compared to other PI are dosing convenience, good tolerability and excellent metabolic profile. These characteristics makes it more like a nonnucleoside than a PI, but with the increased genetic barrier common to PI. It is indicated in initial treatment, simplification treatment or a change due to toxicity and in first line rescue treatment. The administering of ATV boosted with ritonavir (300/100 mg/d) has been approved in Europe in all clinical situations. In naïve patients it has been combined with practically all the nucleoside analogue pairs and has shown to be as effective as lopinavir/ritonavir and even efavirenz. In the USA, this indication has been approved for almost 5 years and ATV has become the most prescribed PI, while the EMEA has approved it this year. ATV is an optimal drug to replace other antiretrovirals in simplification strategies or changes due to toxicity. In several studies it has been shown that, in patients with good virological control, it can LPV/r or another PI, the therapeutic efficacy being maintained, with excellent tolerance and an improved lipid profile, and decreasing the cardiovascular risk. This strategy is widely used in Spain. In this scenario some patients could benefit from non-boosted ATV treatment (400 mg/d). ATV is an effective and very attractive option in first line rescue treatments in which the virus shows little or no resistance to PI, as its simplicity and tolerability can improve problems with compliance, the main cause of therapeutic failure. In patients with moderate resistance to PI, ATV is as effective as LPV/r. The survival of patients with HIV infection is increasingly longer and factors such as tolerability, cardiovascular risk and the adaptability of the treatment to the lifestyle of the patient, become more important, therefore ATV must play an important role in the treatment of HIV-infection.
Ribera Pascuet
Esteban
E
Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España. eribera@vhebron.net
Curran
Adrià
A
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015897:Comorbidity; D004347:Drug Interactions; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D007333:Insulin Resistance; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use; D016879:Salvage Therapy; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate; D019438:Ritonavir