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

By J. M. Llibre, A. Cozzi-Lepri, C. Pedersen, M. Ristola, M. Losso, A. Mocroft, V. Mitsura, K. Falconer, F. Maltez, M. Beniowski, V. Vullo, G. Hassoun, E. Kuzovatova, J. Szlavik, A. Kuznetsova, H. -J. Stellbrink, C. Duvivier, S. Edwards, K. Laut, R. Paredes, M. Losso, M. Kundro, N. Vetter, R. Zangerle, I. Karpov, A. Vassilenko, V. M. Mitsura, D. Paduto, N. Clumeck, S. De Wit, M. Delforge, E. Florence, L. Vandekerckhove, V. Hadziosmanovic, K. Kostov, J. Begovac, L. Machala, D. Jilich, D. Sedlacek, G. Kronborg, T. Benfield, J. Gerstoft, T. Katzenstein, N. F. Moller, C. Pedersen, L. Ostergaard, U. B. Dragsted, L. N. Nielsen, K. Zilmer, J. Smidt, M. Ristola, I. Aho, J. -P. Viard, P. -M. Girard, L. Cotte, C. Pradier, E. Fontas, F. Dabis, D. Neau, C. Duvivier, J. Rockstroh, R. Schmidt, O. Degen, H. J. Stellbrink, C. Stefan, J. Bogner, G. Fatkenheuer, N. Chkhartishvili, J. Kosmidis, P. Gargalianos, G. Xylomenos, P. Lourida, H. Sambatakou, J. Szlavik, M. Gottfredsson, F. Mulcahy, I. Yust, D. Turner, M. Burke, E. Shahar, G. Hassoun, H. Elinav, M. Haouzi, D. Elbirt, Z. M. Sthoeger, D&apos, R. Esposito, I. Mazeu, C. Mussini, F. Mazzotta, A. Gabbuti, V. Vullo, M. Lichtner, M. Zaccarelli, A. Antinori, R. Acinapura, M. Plazzi, A. Lazzarin, A. Castagna, N. Gianotti, M. Galli, A. Ridolfo, B. Rozentale, V. Uzdaviniene, R. Matulionyte, T. Staub, R. Hemmer, P. Reiss, V. Ormaasen, A. Maeland, J. Bruun, B. Knysz, J. Gasiorowski, M. Inglot, A. Horban, E. Bakowska, R. Flisiak, A. Grzeszczuk, M. Parczewski, M. Pynka, K. Maciejewska, M. Beniowski, E. Mularska, T. Smiatacz, M. Gensing, E. Jablonowska, E. Malolepsza, K. Wojcik, I. Mozer-Lisewska, M. Doroana, L. Caldeira, K. Mansinho, F. Maltez, R. Radoi, C. Oprea, A. Rakhmanova, A. Rakhmanova, T. Trofimora, I. Khromova, E. Kuzovatova, D. Jevtovic, A. Shunnar, D. Stanekova, J. Tomazic, J. M. Gatell, J. M. Miro, S. Moreno, J. M. Rodriguez, B. Clotet, A. Jou, R. Paredes, C. Tural, J. Puig, I. Bravo, P. Domingo, M. Gutierrez, G. Mateo, M. A. Sambeat, J. M. Laporte, K. Falconer, A. Thalme, A. Sonnerborg, A. Blaxhult, L. Flamholc, B. Ledergerber, R. Weber, M. Cavassini, A. Calmy, H. Furrer, M. Battegay, P. Schmid, E. Kravchenko, V. Frolov, G. Kutsyna, I. Baskakov, A. Kuznetsova, G. Kyselyova, M. Sluzhynska, B. Gazzard, A. M. Johnson, E. Simons, S. Edwards, A. Phillips, M. A. Johnson, A. Mocroft, C. Orkin, J. Weber, G. Scullard, A. Clarke, C. Leen, J. Lundgren, J. Grarup, R. Thiebaut, D. Burger, L. Peters, C. Matthews, A. H. Fischer, A. Bojesen, D. Raben, D. Kristensen, J. F. Larsen, D. Podlekareva, L. Shepherd and A. Schultze

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) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50copies/mL. We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL 6450copies/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 6450copies/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

Topics: Atazanavir, HIV-1, Protease inhibitors: abacavir, Simplification antiretroviral therapy
Publisher: 'Ovid Technologies (Wolters Kluwer Health)'
Year: 2016
DOI identifier: 10.1097/MD.0000000000005020
OAI identifier: oai:iris.unimore.it:11380/1220746
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