title: Factors involved in continuance of atazanavir-based regimens: Results from a cohort of HIV1-positive patients.
abstract: We evaluated predictive factors involved in durability and therapeutic failure of atazanavir (ATV)-based antiretroviral regimens with or without ritonavir (r) in real life setting. This retrospective study of HIV-1-positive patients evaluated the factors related to ATV continuance and the time-dependent probability of therapeutic failure (HIV-RNA >200 copies/mL and concomitant discontinuation of ATV). We also investigated the rate of therapeutic failure and the variations in total bilirubin levels from starting unboosted ATV-based regimens. The study involved 1030 patients: 183 treatment-naïve patients (17.8%) started ATV/r (17 subsequently switched to unboosted ATV); 653 (63.4%) switched to ATV/r from previous antiretroviral regimens (121 subsequently switched to unboosted ATV); and 194 (18.8%) switched to unboosted ATV from previous ATV-free regimens. The median ATV follow-up was 28 months (interquartile range 7-56). The risk of ATV discontinuation was significantly lower in patients switched to unboosted ATV from ATV/r (HR 0.45; p < 0.0001). The discontinuation of ATV correlated with female gender (HR 1.26; p = 0.035), use of a zidovudine/didanosine/stavudine containing backbone (HR 1.8; p = 0.004), and a baseline CD4+ cell counts of <200/μL (HR 1.54; p = 0.003), the last of which was also associated with a higher risk of therapeutic failure (HR 2.42; p = 0.001). Total bilirubin levels were significantly lower in the patients switching from ATV/r to unboosted ATV. Unboosted ATV-based therapies are safe and effective options in patients whose immuno-virological conditions are stable, and allow the long-term survival of ATV-containing regimens.
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy. Electronic address: andrea.giacomelli@unimi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giacomelli
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Oreni
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Franzetti
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Cristo
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Colella
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Ridolfo
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.affiliation: Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rusconi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D000069446:Atazanavir Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D000069446:Atazanavir Sulfate; D019438:Ritonavir; D001663:Bilirubin
keywords: Antiretroviral; Atazanavir; Continuance; HIV; Unboosted