title: Efficacy and safety of atazanavir/ritonavir-based antiretroviral therapy for HIV-1 infected subjects: a systematic review and meta-analysis.
abstract: Atazanavir (ATZ) is a well-tolerated protease inhibitor that can be boosted with ritonavir (r) to treat infection with resistant strains of human immunodeficiency virus 1 (HIV-1). The aim of this meta-analysis was to compare the efficacy, safety, and metabolic effects of ATZ/r regimen versus commonly used antiretroviral drugs such as lopinavir (LPV) and darunavir (DRV) in HIV-1-infected patients. We searched PubMed, Scopus, Embase and Cochrane CENTRAL, using relevant keywords. Data were extracted from eligible randomized trials and pooled as risk ratios (RR) or standardized mean differences (SMD) in a meta-analysis model using RevMan software. Nine randomized controlled trials (RCTs) (3292 patients) were eligible for the final analysis. After 96 weeks of treatment, the pooled effect estimate did not favor either ATZ/r or LPV/r in terms of virological failure rate (RR 1.11, 95% CI [0.74, 1.66]). However, ATZ/r was marginally superior to LPV/r in terms of increasing the proportion of patients with HIV RNA <50 copies/ml (RR 1.09, 95% CI [1.01, 1.17]). The pooled effect estimate did not favor ATZ/r over DRV/r regarding the change in plasma levels of total cholesterol, triglycerides, or high-density lipoprotein at 24, 48, and 96 weeks. Moreover, no significant difference was found between the two regimens (ATZ/r and DRV/r) in terms of change in visceral (SMD -0.06, 95%CI [-0.33, 0.21]) or subcutaneous adipose tissue (SMD 0.12, 95% CI [-0.15, 0.39]). The ATZ/r regimen was generally as effective and well-tolerated as the LPV/r regimen for the treatment of HIV-1 patients. Compared to the DRV/r regimen, ATZ/r has no favorable effect on the plasma lipid profile or adipose tissue distribution.
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Menshawy
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.|NovaMed Medical Research Association, Cairo, Egypt.
authors.forename: Ammar
authors.initials: A
authors.lastname: Ismail
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt. Abdelrahman.abushouk@med.asu.edu.eg.|NovaMed Medical Research Association, Cairo, Egypt. Abdelrahman.abushouk@med.asu.edu.eg.|Faculty of Medicine, Ain Shams University, Ramsis st, Abbasia, Cairo, 11591, Egypt. Abdelrahman.abushouk@med.asu.edu.eg.
authors.forename: Abdelrahman Ibrahim
authors.initials: AI
authors.lastname: Abushouk
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Zagazig University, El-Sharkia, Egypt.|Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Hussien
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Esraa
authors.initials: E
authors.lastname: Menshawy
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.|NovaMed Medical Research Association, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmaraezy
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gadelkarim
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Maboud
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt.|Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Attia
authors.initials: A
authors.lastname: Attia
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Zagazig University, El-Sharkia, Egypt.|Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Negida
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000069446:Atazanavir Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D000069454:Darunavir / Q000009:adverse effects / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D061466:Lopinavir / Q000009:adverse effects / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir; D000069454:Darunavir