Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study
Por:
Llibre, JM, 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, HJ, Duvivier, C, Edwards, S, Laut, K, Paredes, R, Domingo P., Gutierrez, M., Mateo, G., Sambeat, MA, Schultze, Alexander
Publicada:
1 oct 2016
Resumen:
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 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.
Filiaciones:
Llibre, JM:
Univ Hosp Germans Trias & Pujol, Infect Dis & Lluita SIDA Fdn, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Cozzi-Lepri, A:
UCL, Res Dept Infect & Populat Hlth, London, England
Pedersen, C:
Odense Univ Hosp, Dept Infect Dis, Odense, Denmark
Ristola, M:
Helsinki Univ Hosp, Dept Infect Dis, Helsinki, Finland
Losso, M:
Hosp Gen Agudos JM Ramos Mejia, Dept Infect Dis, Buenos Aires, DF, Argentina
Mocroft, A:
UCL, Dept Epidemiol & Med Stat, London, England
Mitsura, V:
Gomel State Med Univ, Dept Infect Dis, Gomel, BELARUS
Falconer, K:
Karolinska Univ Hosp, Stockholm, Sweden
Maltez, F:
Curry Cabral Hosp, Dept Infect Dis, Lisbon, Portugal
Beniowski, M:
Specialist Hosp, Outpatient Clin AIDS Diagnost & Therapy, Chorzow, Poland
Vullo, V:
Policlin Umberto 1, Rome, Italy
Hassoun, G:
Rambam Hlth Care Campus, Haifa, Israel
Kuzovatova, E:
Nizhny Novgorod Sci & Res Inst Epidemiol & Microb, Nizhnii Novgorod, Russia
Szlavik, J:
Szent Laszlo Hosp, Budapest, Hungary
Kuznetsova, A:
Kharkov State Med Univ, Kharkov, Ukraine
Stellbrink, HJ:
ICH Study Ctr, Hamburg, Germany
Duvivier, C:
Hop Necker Enfants Malad, AP HP, Ctr Infect Dis, Paris, France
Edwards, S:
Mortimer Market Ctr, London, England
Laut, K:
Univ Copenhagen, Rigshosp, Dept Infect Dis, Ctr Hlth & Infect Dis Res CHIP,Sect 2100, Copenhagen, Denmark
Paredes, R:
Univ Hosp Germans Trias & Pujol, Infect Dis & Lluita SIDA Fdn, Barcelona, Spain
Irsi Caixa AIDS Res Inst, Badalona, Spain
Domingo P.:
Hospital Sant Pau, Barcelona, Spain
Gutierrez, M.:
Hospital Sant Pau, Barcelona, Spain
Mateo, G.:
Hospital Sant Pau, Barcelona, Spain
Sambeat, MA:
Hospital Sant Pau, Barcelona, Spain
Schultze, Alexander :
Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Gold, Green Published
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