title: Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study.
abstract: Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant.We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50 copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50 copies/mL.We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50 copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28%), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10%). Ninety (32%) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90%/87%/88% (TLOVR) and 74%/67%/59% (snapshot analysis), respectively. The rates of VF were 8%/8%/6%. Rates of adverse events leading to study discontinuation were 0.4%/1%/2%. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95% confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50 copies/mL (HR 0.87 [95% CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95% CI: 1.28-6.04]). Resistance selection at failure was uncommon.A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.
authors.affiliation: Infectious Diseases and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain Research Department of Infection and Population Health, University College London, London, UK Odense University Hospital, Department of Infectious Diseases, Odense, Denmark Helsinki University Hospital, Department of Infectious Diseases, Helsinki, Finland Hospital General de Agudos JM Ramos Mejía, Department of Infectious Diseases, Buenos Aires, Argentina Department of Epidemiology and Medical Statistics, University College London, London, UK Department of Infectious Diseases, Gomel State Medical University, Gomel, Belarus Karolinska University Hospital, Stockholm, Sweden Curry Cabral Hospital, Department of Infectious Diseases, Lisbon, Portugal Specialistic Hospital, Outpatient Clinic for AIDS Diagnostics and Therapy, Chorzów, Poland Policlinico Umberto 1, Rome, Italy Rambam-Health Care Campus, Haifa, Israel Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Russia Szent László Hospital, Budapest, Hungary Kharkov State Medical University, Ukraine ICH Study Center, Hamburg, Germany Infectious Diseases Center Necker-Pasteur, APHP-Hôpital Necker-Enfants Malades, Paris, France Mortimer Market Centre, UK Centre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Irsi-Caixa AIDS Research Institute, Badalona, Spain..
authors.forename: Josep M
authors.initials: JM
authors.lastname: Llibre
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Matti
authors.initials: M
authors.lastname: Ristola
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Viktar
authors.initials: V
authors.lastname: Mitsura
authors.forename: Karolin
authors.initials: K
authors.lastname: Falconer
authors.forename: Fernando
authors.initials: F
authors.lastname: Maltez
authors.forename: Marek
authors.initials: M
authors.lastname: Beniowski
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
authors.forename: Gamal
authors.initials: G
authors.lastname: Hassoun
authors.forename: Elena
authors.initials: E
authors.lastname: Kuzovatova
authors.forename: János
authors.initials: J
authors.lastname: Szlavik
authors.forename: Anastasiia
authors.initials: A
authors.lastname: Kuznetsova
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Claudine
authors.initials: C
authors.lastname: Duvivier
authors.forename: Simon
authors.initials: S
authors.lastname: Edwards
authors.forename: Kamilla
authors.initials: K
authors.lastname: Laut
authors.forename: Roger
authors.initials: R
authors.lastname: Paredes
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069446:Atazanavir Sulfate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015224:Dideoxynucleosides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019438:Ritonavir / Q000627:therapeutic use; D012737:Sex Factors; D019562:Viral Load / Q000187:drug effects; D000099227:Abacavir
chemical_list: D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate; D015224:Dideoxynucleosides; D004338:Drug Combinations; D017320:HIV Protease Inhibitors; D019259:Lamivudine; D019438:Ritonavir; C492871:abacavir, lamivudine drug combination; D000099227:Abacavir