Project Inform Perspectives 43 - October, 2007

As reported in the April 2007 issue of the journal, AIDS, a study examining the use of Reyataz (atazanavir) as monotherapy was stopped early due to high rate of virologic breakthrough. The researchers planned to study 30 people, with undetectable HIV for at least one year on conventional HAART. They would be switched from their regimen to a once-a-day regimen of 300mg of Reyataz + 100mg of Norvir (ritonavir). The study was halted after 15 people were recruited because there were 5 cases of rebounding HIV levels. The five cases of viral rebound happened between 12 and 16 weeks after starting Reyataz monotherapy.

The researchers looked to see if there was a connection between levels of Reyataz measured in the blood and the risk of viral rebound, and found none. They did find a connection between levels of bilirubin (a protein found in blood) and the risk of failure. The authors argue for more research to understand the connection between bilirubin and treatment outcomes with Reyataz.

There has been some interest among researchers in studying certain anti-HIV drugs as possible monotherapy. This interest stems largely from Dr. Joel Gath’s research on Kaletra monotherapy—which found it to be fairly successful, but not as much so as conventional HAART. Reyataz drew interest due to the combination of its potency and its high barrier to resistance. This study suggests that the risk of early virologic breakthrough on Reyataz monotherapy is unacceptably high.

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