title: Outcomes of switch to atazanavir-containing combination antiretroviral therapy in HIV-1-infected patients with hyperlipidemia.
abstract: BACKGROUND
  Prolonged exposure to combination antiretroviral therapy (CART) may result in hyperlipidemia and other metabolic complications. This study aimed to evaluate the clinical, virologic, and immunologic outcomes in HIV-infected patients with hyperlipidemia whose CART was switched to atazanavir-containing antiretroviral regimens.
  
  
  METHODS
  In this 48-week prospective, observational study that was conducted at designated hospitals for HIV care in Taiwan, HIV-infected patients aged 18 years or older who had developed hyperlipidemia after receiving CART that did not contain atazanavir were enrolled. Antiretroviral regimens were switched to regimens containing two nucleoside reverse-transcriptase inhibitors plus atazanavir 400 mg once daily or atazanavir 300 mg boosted with ritonavir 100 mg once daily. The lipid profiles, including total triglycerides, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, CD4+ lymphocyte counts, and plasma HIV RNA load were determined every 3 months.
  
  
  RESULTS
  Sixty-six patients with hyperlipidemia were enrolled. At the end of the study, triglyceride levels declined by 49.0% (p = 0.0002) and total cholesterol levels by 18.1% from baseline (p < 0.0001), whereas there were no significant changes observed for low-density lipoprotein- and high-density lipoprotein-cholesterol levels. Mean CD4 lymphocyte count increased from 465 cells/μL at baseline to 498 cells/μL at the end of the study, whereas the proportion of patients with undetectable plasma HIV RNA load increased from 73.1% to 81.7%. The regimens were well tolerated.
  
  
  CONCLUSIONS
  Switch to atazanavir-containing regimens that were well tolerated resulted in significant improvement of hyperlipidemia and maintenance of clinical, immunologic, and virologic responses to CART.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu branch, Hsin-Chu, Taiwan.
authors.forename: Ching-Lan
authors.initials: CL
authors.lastname: Lu
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Lin
authors.forename: Wing-Wai
authors.initials: WW
authors.lastname: Wong
authors.forename: Hsi-Hsin
authors.initials: HH
authors.lastname: Lin
authors.forename: Mao-Wang
authors.initials: MW
authors.lastname: Ho
authors.forename: Ning-Chi
authors.initials: NC
authors.lastname: Wang
authors.forename: Szu-Min
authors.initials: SM
authors.lastname: Hsieh
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Chen
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods; D000069446:Atazanavir Sulfate; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced* / Q000821:virology; D008297:Male; D009842:Oligopeptides / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D014280:Triglycerides; D000069446:Atazanavir Sulfate