Abstract
BACKGROUND: Current clinical guidelines consider regimens consisting of either ritonavir-boosted atazanavir or ritonavir-boosted lopinavir and a nucleoside reverse transcriptase inhibitor (NRTI) backbone among their recommended and alternative first-line antiretroviral regimens. However, these guidelines are based on limited evidence from randomized clinical trials and clinical experience.
METHODS: We compared these regimens with respect to clinical, immunologic, and virologic outcomes using data from prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States in the HIV-CAUSAL Collaboration, 2004-2013. Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started a lopinavir or an atazanavir regimen. We estimated the 'intention-to-treat' effect for atazanavir vs lopinavir regimens on each of the outcomes.
RESULTS: A total of 6668 individuals started a lopinavir regimen (213 deaths, 457 AIDS-defining illnesses or deaths), and 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths). The adjusted intention-to-treat hazard ratios for atazanavir vs lopinavir regimens were 0.70 (95% confidence interval [CI], .53-.91) for death, 0.67 (95% CI, .55-.82) for AIDS-defining illness or death, and 0.91 (95% CI, .84-.99) for virologic failure at 12 months. The mean 12-month increase in CD4 count was 8.15 (95% CI, -.13 to 16.43) cells/µL higher in the atazanavir group. Estimates differed by NRTI backbone.
CONCLUSIONS: Our estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a greater 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for atazanavir compared with lopinavir regimens.
Original language | English |
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Pages (from-to) | 1262-8 |
Number of pages | 7 |
Journal | Clinical Infectious Diseases |
Volume | 60 |
Issue number | 8 |
DOIs | |
Publication status | Published - 15 Apr 2015 |
Keywords
- Adolescent
- Adult
- Anti-HIV Agents
- Antiretroviral Therapy, Highly Active
- Atazanavir Sulfate
- CD4 Lymphocyte Count
- Cohort Studies
- Cooperative Behavior
- Developed Countries
- Europe
- Female
- HIV Infections
- Humans
- Lopinavir
- Male
- Middle Aged
- Prospective Studies
- Treatment Outcome
- United States
- Viral Load
- Young Adult
- Journal Article
- Observational Study
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't