A meta‐analysis of the efficacy and safety of unboosted atazanavir compared with ritonavir‐boosted protease inhibitor maintenance therapy in HIV‐infected adults with established virological suppression after induction. Issue 5 (9th December 2013)

• Record Type: Journal Article
• Authors: Baril, J; Conway, B; Giguère, P; Ferko, N; Hollmann, S; Angel, JB
• Is Part Of: HIV medicine. Volume 15:Issue 5(2014:May)
• Page Start: 301
• Page End: 310
• Publication Date: 2013-12-09
• Subjects: HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12118
• Languages: English
• ISSNs: 1464-2662

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hiv12118-sec-0001" sec-type="section"> <title>Objectives</title> <p>Treatment simplification involving induction with a ritonavir (RTV)‐boosted protease inhibitor (PI) replaced by a nonboosted PI (i.e. atazanavir) has been shown to be a viable option for long‐term antiretroviral therapy. To evaluate the clinical evidence for this approach, we conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) evaluating efficacy and safety in patients with established virological suppression.</p> </sec> <sec id="hiv12118-sec-0002" sec-type="section"> <title>Methods</title> <p>Several databases were searched without limits on time or language. Searches of conferences were also conducted. RCTs were included if they compared a PI/RTV regimen to unboosted atazanavir, after induction with PI/RTV. The meta‐analysis was conducted using a random effects model for the proportion achieving virological suppression (i.e. HIV RNA < 50 and <400 HIV‐1 RNA copies/mL), CD4 cell counts, lipid levels and liver function tests. Dichotomous outcomes were reported as risk ratios (RRs) and continuous outcomes as mean differences (MDs).</p> </sec> <sec id="hiv12118-sec-0003" sec-type="section"> <title>Results</title> <p>Five studies (<italic>n</italic> = 1249) met the inclusion criteria. The meta‐analysis demonstrated no statistically significant difference in efficacy (i.e. HIV RNA < 50 copies/mL) between PI/RTV and unboosted atazanavir [RR = 1.04; 95% confidence interval (CI) 0.99 to 1.10], with no heterogeneity. Findings were similar in a subanalysis of studies where atazanavir/RTV was the only PI/RTV used during induction. Additional efficacy results support these findings. A significant reduction in total cholesterol (<italic>P</italic> < 0.00001), triglycerides (<italic>P</italic> = 0.0002), low‐density lipoprotein (LDL) cholesterol (<italic>P</italic> = 0.009) and hyperbilirubinaemia (<italic>P</italic> = 0.02) was observed with unboosted atazanavir <italic>vs.</italic> PI/RTV.</p> </sec> <sec id="hiv12118-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The meta‐analysis demonstrated that switching patients with virological suppression from an RTV‐boosted PI to unboosted atazanavir leads to improvements in safety (i.e. blood parameter abnormalities) without sacrificing virological efficacy.</p> </sec> </abstract>