title: Impact of switching from lopinavir/ritonavir to boosted and un-boosted atazanavir on glucose metabolism: the ATAzanavir & GLUcose metabolism (ATAGLU) study.
abstract: Previous studies have reported that protease inhibitors (PIs) can contribute to glycaemic alterations. However, there are few trials examining the direct effect of a single PI. The objective of the study was to evaluate the modifications of glucose and lipid profiles after a switch from lopinavir/ritonavir (LPV/r) to atazanavir, used as ritonavir-boosted (ATV/r) or un-boosted. We conducted a retrospective observational cohort study on the effect of ATV/(r) on glycaemic metabolism (ATAGLU) in patients with undetectable levels of HIV-RNA who switched from LPV/r. In total, 235 patients treated for 48 weeks with LPV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) and with undetectable HIV-RNA were included: 134 continued LPV/r after the initial 48 weeks and 101 switched to ATV(/r) (18.3% to ATV; 24.7% to ATV/r). A significant decrease in mean glucose level and insulin resistance was observed in patients who switched to ATV(/r). The mean cholesterol triglyceride levels increased in the LPV/r group and decreased among the patients who switched. A significant increase of CD4 T cells with undetectable levels of HIV-RNA was observed in all groups. The long-term results obtained in this real-life study suggest that patients who have achieved initial suppression on a regimen including LPV/r + two NRTIs can switch to ATV/(r) + two NRTIs with an improvement in lipid and glycaemic metabolism.
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: d'Ettorre
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy giancarlo.ceccarelli@uniroma1.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Ceccarelli
authors.affiliation: Clinical Department, National Institute for infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Zaccarelli
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Ascoli-Bartoli
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bianchi
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Bellelli
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: De Girolamo
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Serafino
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Noemi
authors.initials: N
authors.lastname: Giustini
authors.affiliation: Department of Infectious Diseases, University of Rome "Sapienza" (Polo Pontino), Latina, Italy.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Mastroianni
authors.affiliation: Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects*; D061466:Lopinavir / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir
keywords: AIDS; HIV; antiretroviral therapy; atazanavir; cardiovascular risk; glucose; glycaemic metabolism; insulin resistance; lopinavir; protease inhibitor; ritonavir; switch study; treatment