Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial

Soriano, Vincent; García-Gascó, Pilar; Vispo, Eugenia; Ruiz-Sancho, Andrés; Blanco, Francisco J.; Martín‐Carbonero, Luz; Rodrı́guez-Nóvoa, Sonia; Morello, Judit; Mendoza, Carrnen De; Rivas, Pedro; Barreiro, Pablo; González-Lahoz, Juan

doi:10.1093/jac/dkm413

Cited by 74 publications

(61 citation statements)

References 19 publications

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“…3,4 Atazanavir (ATV), unboosted or boosted with ritonavir (ATV/r), seems less likely to cause dyslipidemia and other adverse metabolic effects compared with other PIs. [5][6][7][8][9] These findings have been observed both in naive and in pretreated patients. [5][6][7][8][9][10] Several studies switching from other PIs, including lopinavir/ritonavir (LPV/r) to ATV/r, have been previously conducted with the aim of simplifying therapy and improving tolerability and the lipid profile.…”

mentioning

confidence: 67%

“…[5][6][7][8][9] These findings have been observed both in naive and in pretreated patients. [5][6][7][8][9][10] Several studies switching from other PIs, including lopinavir/ritonavir (LPV/r) to ATV/r, have been previously conducted with the aim of simplifying therapy and improving tolerability and the lipid profile. 6,8,9 However, little information is available comparing body fat changes between patients receiving different PIs, and specifically, the effect of switching from LPV/r to ATV/r on changes in body composition remains unclear.…”

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confidence: 67%

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Impact of Switching from Lopinavir/Ritonavir to Atazanavir/Ritonavir on Body Fat Redistribution in Virologically Suppressed HIV-Infected Adults

Ferrer

Río²,

Martínez

et al. 2011

AIDS Research and Human Retroviruses

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Changes in body fat distribution in virologically suppressed HIV-infected patients switching from lopinavir/ ritonavir (LPV/r) to atazanavir/ritonavir (ATV/r) were assessed. A prospective comparative study was conducted of 37 patients receiving LPV/r regimens switching to ATV/r with 46 patients continuing with LPV/r. Body composition was assessed with whole-body dual-energy x-ray absorptiometry (DXA). Abdominal CT scans were also performed in a subset of patients. Groups were comparable in baseline demographic, clinical, and anthropometric characteristics. After 12 months, peripheral fat did not change significantly, but an increase in trunk fat was observed only in the ATV/r group (0.87 kg, p ¼ 0.021). The percentage of patients with an increase !20% in total fat was 37.8% and 15.2% in the ATV/r and LPV/r groups, respectively ( p ¼ 0.018). In the ATV/r group, the increase in trunk fat (9.4%) was significantly higher than in peripheral fat (3.7%) ( p ¼ 0.007), leading to a significant increase in fat mass ratio (3.76%, p ¼ 0.028), whereas no significant differences were found among LPV/r patients. CT scans showed that abdominal fat increase corresponded to both visceral (28%, p ¼ 0.008) and subcutaneous fat (42%, p ¼ 0.008). These data suggest that switching from LPV/r to ATV/r is associated with increased trunk fat, both subcutaneous and visceral.

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confidence: 67%

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confidence: 67%

Impact of Switching from Lopinavir/Ritonavir to Atazanavir/Ritonavir on Body Fat Redistribution in Virologically Suppressed HIV-Infected Adults

Ferrer

Río²,

Martínez

et al. 2011

AIDS Research and Human Retroviruses

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“…The SLOAT (Simplification Lopinavir to Atazanavir) study monitored 66 patients receiving LPV/r-based regimens. 53 All patients had undetectable HIV plasma RNA for .24 weeks and were randomized to continue on the same therapy or switch to either ATV (400 mg od) or ATV/r (300/100 mg od) if receiving TFV. There was no significant difference between the two groups in rates of virological failures at 48 weeks.…”

Section: Simplificationmentioning

confidence: 99%

Clinical utility and long-term use of atazanavir in the treatment of HIV-1 infection

Rampling¹,

Nelson²

2011

VAAT

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Abstract:The protease inhibitor atazanavir (ATV) now forms an integral component of many combination antiretroviral regimens. It has been shown to have a favorable side effect profile, and it does not negatively affect plasma lipids as some other protease inhibitors can. ATV also has a long half-life, which allows for a once-daily dosing schedule. Coadministration of ATV with low-dose ritonavir (RTV) potentiates the effect of ATV ("RTV boosting"), allowing for lower doses of ATV than those prescribed without RTV. ATV boosted with RTV (ATV/r) has shown noninferiority to RTV-boosted lopinavir (LPV/r), and it has been shown to be effective as a simplification strategy in switch studies. ATV/r-based regimens have also shown promise as a rescue strategy for patients failing other regimens. Several important adverse events and drug interactions have been identified, and care must be taken when administering ATV with other medications. The most commonly reported adverse effect is unconjugated hyperbilirubinemia, which occurs as a result of the metabolic pathway by which it is excreted. Resistance to ATV has been described in both treatment-experienced and treatment-naïve patients.

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“…17,18 Other boosted PIs with more favourable reported lipid profiles may also be useful if a change of drug regimen is being considered.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

HIV and cardiovascular risk

Moyle

Randell

2008

Clinical Medicine

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Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial

Abstract: The replacement of lopinavir/ritonavir by atazanavir provides an overall significant reduction in total cholesterol and triglycerides, without increased risk of virological failure.

Cited by 74 publications

References 19 publications

Impact of Switching from Lopinavir/Ritonavir to Atazanavir/Ritonavir on Body Fat Redistribution in Virologically Suppressed HIV-Infected Adults

Impact of Switching from Lopinavir/Ritonavir to Atazanavir/Ritonavir on Body Fat Redistribution in Virologically Suppressed HIV-Infected Adults

Clinical utility and long-term use of atazanavir in the treatment of HIV-1 infection

HIV and cardiovascular risk

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