Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression : A prospective cohort study

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Llibre , J M , Cozzi-Lepri , A , Pedersen , C , Ristola , M , Losso , M , Mocroft , A , Mitsura , V , Falconer , K , Maltez , F , Beniowski , M , Vullo , V , Hassoun , G , Kuzovatova , E , Szlavik , J , Kuznetsova , A , Stellbrink , H-J , Duvivier , C , Edwards , S , Laut , K & Paredes , R 2016 , ' Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression : A prospective cohort study ' Medicine (Baltimore) , vol. 95 , no. 40 , 5020 . DOI: 10.1097/MD.0000000000005020

Title: Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression : A prospective cohort study
Author: Llibre, Josep M.; Cozzi-Lepri, Alessandro; Pedersen, Court; Ristola, Matti; Losso, Marcelo; Mocroft, Amanda; Mitsura, Viktar; Falconer, Karolin; Maltez, Fernando; Beniowski, Marek; Vullo, Vincenzo; Hassoun, Gamal; Kuzovatova, Elena; Szlavik, Janos; Kuznetsova, Anastasiia; Stellbrink, Hans-Juergen; Duvivier, Claudine; Edwards, Simon; Laut, Kamilla; Paredes, Roger
Contributor: University of Helsinki, Clinicum
Date: 2016-10
Language: eng
Number of pages: 7
Belongs to series: Medicine (Baltimore)
ISSN: 0025-7974
URI: http://hdl.handle.net/10138/169330
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 50copies/mL.We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL 50copies/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 50copies/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.
Subject: atazanavir
HIV-1
protease inhibitors: abacavir
simplification antiretroviral therapy
HIV-INFECTED PATIENTS
ACTIVE ANTIRETROVIRAL THERAPY
BOOSTED ATAZANAVIR
HEPATITIS-C
RITONAVIR
EFFICACY
SAFETY
REGIMENS
PROTEASE
ADULTS
3121 Internal medicine
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