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Journal of AIDS & Clinical Research

ISSN: 2155-6113

Open Access

Low-Dose Ritonavir-Boosted Atazanavir (200/100 mg) Maintained a High Virological Efficacy Up To 4 Years in Treatment-Experienced HIV-1 Infected Adults: A Prospective Cohort Study from Asia

Abstract

Anchalee Avihingsanon, Tanakorn Apornpong, Stephen J Kerr, Wirach Make-a-nantawat, Narukjaporn Thammajaruk, Supalak Phonphithak, Reshmie A Ramautarsing, Amanda Clarke, Praphan Phanuphak, David M Burger, Kiat Ruxrungtham and HIV-NAT 006 Study Team

Background: HIV requires lifelong treatment so ARV dose optimization is important for long-term efficacy and safety. Previously, low-dose atazanavir (ATV)/ritonavir(r) plus 2 NRTIs in HIV-infected Thai patients provided adequate plasma ATV concentrations and reduced risk of hyperbilirubinemia. However, long-term efficacy and safety data is limited.

Methods: 127 HIV-infected adults on ATV/r200/100mg plus 2 NRTIs were prospectively followed in Thailand. CD4 cell counts, HIV-RNA, and safety parameters were performed every 6 months. Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology (CKD-EPI). ATV plasma concentrations (ATV Ctrough) were assessed.

Results: Median body weight was 60 kg and 50% were females. Previous regimens were mainly standard dose ATV/r (54%) and lopinavir/r (29%). 93% of them were on tenofovir and 9.4% had HIV-RNA > 50 copies/mL at the time when lower dose of ATV/r was initiated. The median duration of lower dose ATV/r was 154 (IQR 65-271) weeks and 50.4% had been followed for more than 3 years. HIV-RNA < 50 copies/mL by on-treatment and intention-to-treat analysis were 91.2% and 81.8%, respectively. Bilirubin and eGFR significantly improved [83 to 88 ml/min/1.73m2 (p<0.001)]. Premature discontinuation occurred in 13 (10.2%) patients due to toxicity (CKD, renal stone, hepatitis, pancreatitis) and death (sepsis, cerebral aneurysm, CKD). All 42 cases with available ATV Ctrough had adequate ATV concentrations of >0.15 mg/L.

Conclusions: Long-term use of ATV/r 200 mg/100 mg based-HAART as a maintenance therapy for patients who are sensitive to PI was efficacious and well-tolerated. Use of low-dose ATV/r could benefit resource limited settings because it will reduce toxicity, increase accessibility and save costs.

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Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Received Date: Jan 01, 1970
Accepted Date: Jan 01, 1970
Published Date: Jan 01, 1970

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