title: Boosted or unboosted atazanavir as a simplification of lopinavir/ritonavir-containing regimens.
abstract: Switches from lopinavir/ritonavir (LPV/r) to either atazanavir/ritonavir (ATV/r) or unboosted ATV (ATV) are increasingly common in clinical practice, but data on outcome comparison between these two simplification strategies are very limited.
  
  
  METHODS
  Multicenter, observational, retrospective study. Data were collected from five Italian clinics. The objective of the study was to investigate the outcome of LPV/r simplification with ATV/r or ATV and to identify factors predicting virological rebound. Patients who switched from LPV/r to ATV/r or ATV with an HIV-RNA value<50 copies/mL at the time of switch and with at least one follow-up visit were included. We evaluated 468 patients (74.1% males), followed for a median (Q1-Q3) of 547 (305-788) days: 380 (81%) and 88 (19%) switched to ATV/r and to ATV, respectively. Virological rebound was detected in 78/468 (16.7%, 95% CI: 13.6 -20.3) patients [16/88 (18.2%, 95% CI: 11.4 -27.6) switched to ATV and 62/380 (16.3%, 95% CI: 12.9 -20.4) to ATV/r (p=0.638)]. Virological rebound was more frequent in patients who started LPV/r with HIV-RNA >30000 copies/mL (28% vs 6%, p=0.014). Replacing lopinavir/r with ATV or ATV/r yielded similar rates of virological rebound. Viral load at the initiation of lopinavir/r may be useful in driving the choice between ATV/r and ATV.
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Laura
authors.initials: L
authors.lastname: Galli
authors.forename: Nicola
authors.initials: N
authors.lastname: Gianotti
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Renato
authors.initials: R
authors.lastname: Maserati
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Eugenia
authors.initials: E
authors.lastname: Quiros-Roldan
authors.forename: Stefania
authors.initials: S
authors.lastname: Salpietro
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D061466:Lopinavir / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009842:Oligopeptides / Q000008:administration & dosage*; D011725:Pyridines / Q000008:administration & dosage*; D012189:Retrospective Studies; D019438:Ritonavir / Q000008:administration & dosage*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir