title: Switch to Ritonavir-Boosted versus Unboosted Atazanavir plus Raltegravir Dual-Drug Therapy Leads to Similar Efficacy and Safety Outcomes in Clinical Practice.
abstract: OBJECTIVE
  To assess immunovirological response, safety and pharmacokinetic of NRTI-sparing regimen dual therapy of atazanavir (ATV) and raltegravir (RAL) in maintenance strategy.
  
  
  METHODS
  A retrospective analysis was conducted on a cohort of HIV-infected adults followed in French centers (Dat'AIDS cohort), comparing the proportions of virological and therapeutic failures between ATV + RAL and ATV/ritonavir + RAL dual therapy regimens.
  
  
  RESULTS
  283 patients were assessed: 185 switched for ATV + RAL and 98 for ATV/ritonavir + RAL dual therapy. Virological failure rate at week 96 was 13.8% (95% CI, 9.8-17.8), without difference between the two groups (Log-rank Test, p = 0.87). The cumulative percentages of patients remaining free of therapeutic failure at week 24, 48 and 96 of dual therapy were 74.9% (95% CI, 69.9-80.0), 65.4% (95% CI, 59.8-70.9) and 53.4% (95% CI, 47.5-59.2), respectively. Four out of 39 confirmed virological failures developed RAL resistance. By multivariate analysis, virological failure was associated with high HIV-1 RNA zenith (p = 0.02), low CD4+ T-cell count at baseline (p<0.001) and short duration on antiretroviral therapy (p<0.001). Before week 96, dual therapy was discontinued in 44 patients (16%) because of various adverse events, with no difference between the two groups. Minimal plasma levels were targeted in 84% and 87% of patients for ATV and RAL, respectively, and both were significantly higher in ritonavir-boosted regimen.
  
  
  CONCLUSIONS
  Emerging RAL-resistance and discontinuations for adverse events resulted in moderate efficacy rates of ATV and RAL dual therapy in heavily pretreated patients.
authors: Le Trait d'Union, HIV-infection care center, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: Pierre
authors: P
authors: Gantner
authors: Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France.
authors: Firouze
authors: F
authors: Bani-Sadr
authors: Pharmacologie clinique, Pasteur University Hospital, Nice, France.
authors: Rodolphe
authors: R
authors: Garraffo
authors: Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France.
authors: Pierre-Marie
authors: PM
authors: Roger
authors: Laboratoire de Biostatistiques, Faculté de Médecine, Strasbourg, France.
authors: Michèle
authors: M
authors: Treger
authors: Service d'Infectiologie, Service des Maladies Infectieuses et Tropicales, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors: Thomas
authors: T
authors: Jovelin
authors: Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France.
authors: Pascal
authors: P
authors: Pugliese
authors: Le Trait d'Union, HIV-infection care center, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: David
authors: D
authors: Rey
mesh_terms: D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate / Q000494:pharmacology / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D024882:Drug Resistance, Viral; D057915:Drug Substitution; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D019438:Ritonavir / Q000494:pharmacology / Q000627:therapeutic use*; D061665:Time-to-Treatment; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate; D019438:Ritonavir