title: Less-drug regimen including atazanavir in maintenance treatment of HIV infection: how, who, when, why?
abstract: For many patients living with HIV-1, the efficacy of combined ART (cART) has made the infection turn to a chronic disease. Because cART is associated with a risk of long-term toxicity, switching patients with virological success to another therapy remains a major issue. Studies undertaken and published over recent years have shown that switching patients exhibiting virological suppression to less-drug regimens (LDR) is a possible option of maintenance strategy. The use of ritonavir-boosted PIs (PI/r) as the backbone of LDR-based maintenance therapy is consistent with their virological potency and a high genetic barrier of resistance. Atazanavir is the most documented PI/r regarding maintenance in dual therapy, with favourable results in terms of virological suppression, tolerance improvement and absence of emergence of mutations. Furthermore, atazanavir is the only commonly prescribed PI that can be used after withdrawal of ritonavir, with maintenance of virological suppression whatever the backbone of associated NRTIs. Based on clinical studies, and taking into account the characteristics of the patients included, one may consider that for any patient with a virological suppression on cART for at least 12 months, with the nadir CD4 >100 cells/mm3and an absence of encephalitis, an LDR-based maintenance therapy including atazanavir can be considered. Cumulative genotypes must be available to make sure that the LDR will not jeopardize future therapeutic options. The final decision regarding the most appropriate LDR must be guided by the objectives shared by the physician and his/her patient.
authors.affiliation: Service de Virologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France vincent.calvez@me.com.
authors.forename: Vincent
authors.initials: V
authors.lastname: Calvez
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, AP-HP, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Meynard
authors.affiliation: Laboratoire de Pharmacologie Clinique, INSERM UMR 1098, Centre Hospitalier Régional Universitaire Minjoz, Besançon, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Muret
authors.affiliation: Unité de Maladies Infectieuses et Tropicales, Hôpital Eugénie, Ajaccio, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Castan
authors.affiliation: Laboratoire de Virologie, Hôpital de la Croix Rousse, Hospices Civils, Lyon, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardy
authors.affiliation: Département de Pharmaco-Toxicologie, Hôpital Bichat-Claude Bernard, AP-HP and Université Paris Diderot Sorbonne Paris Cité, IAME, INSERM UMR 1137, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP and Institut National de la Santé et de la Recherche Médicale UMR 1137, Paris, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Landman
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000069446:Atazanavir Sulfate / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D060046:Maintenance Chemotherapy / Q000379:methods*; D000072230:Sustained Virologic Response; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate