HIV/AIDS Adverse Drug Reaction: Atazanavir/ritonavir combination has fewer adverse effects than lopinavir/ritonavir

AIDSWEEKLY Plus; Monday, May 29, 2006
Staff Medical Writers

According to recent research from England, "In BMS Study 045, once-daily (QD) atazanavir/ritonavir (ATV/RTV) demonstrated comparable efficacy and safety to twice-daily (BID) lopinavir/ritonavir (LPV/RTV) over 48 weeks in treatment-experienced patients. Results of extended follow-up to 96 weeks are presented."

"BMS Study 045 was an open-label, randomized, multinational trial of HIV-infected patients with virologic failure on two or more prior HAART regimens designed to evaluate the efficacy and safety of ATV/RTV (300/100 mg) QD and LPV/RTV (400/100 mg) BID, each with tenofovir (300 mg) QD and one nucleoside reverse transcriptase inhibitor."

"The primary efficacy measure was the time-averaged difference (TAD) in reduction in HIV RNA from baseline. Secondary objectives included evaluation of safety and plasma lipid levels through week 96," M. Johnson and colleagues at Royal Free Hospital in London said.

"Over 96 weeks," reported the authors, "the ATV/RTV regimen demonstrated similar virologic efficacy to the LPV/RTV regimen. Mean reductions from baseline in HIV RNA were: -2.29 and -2.08 log₁₀ copies/ml, respectively ITAD (97.5% confidence interval): 0.14 log₁₀ copies/ml (-0.13, 0.41).

"The LPV/RTV regimen resulted in significant increases in total cholesterol (+9%) and fasting triglycerides (+30%) in comparison with the ATV/RTV regimen, which demonstrated decreases in these parameters [-7 and -2%, respectively, (p<0.0001)]."

Investigators continued, "Grade 2-4 diarrhea occurred less frequently in ATV/RTV patients (3%) in comparison with LPV/RTV patients (13%) (p<0.01). Grade 3-4 elevations in bilirubin were more common in ATV/RTV patients (53%) than LPV/RTV patients (<1%) (p<0.0001), with no resulting discontinuations."

"Regimens containing once-daily ATV/RTV demonstrated comparable efficacy and safety, with significant reductions in total cholesterol and fasting triglycerides and improved gastrointestinal-tolerability in comparison with twice-daily regimens containing LPV/RTV over 96 weeks in treatment-experienced patients," Johnson concluded.

Johnson and colleagues published their study in AIDS (96-week comparison of once-daily atazanavir/ritonavir and twice-daily lopinavir/ritonavir in patients with multiple virologic failures. AIDS. 2006 Mar 21;20(5):711-8).

For additional information, contact M. Johnson, Royal Free Hospital, Pond St., London NW3 2QG, England.

Publisher contact information for the journal AIDS is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

Keywords: London, England, HIV/AIDS, Once-Daily Atazanavir/Ritonavir, Twice-Daily Lopinavir/Ritonavir, Safety & Efficacy, Viral Load.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Johnson M, Grinsztejn B, Rodriguez C, et al., "96-week comparison of once-daily atazanavir/ritonavir and twice-daily lopinavir/ritonavir in patients with multiple virologic failures", AIDS. 2006 Mar 21;20(5):711-8.

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