TY - JOUR
T1 - Boosted Lopinavir- Versus Boosted Atazanavir-Containing Regimens and Immunologic, Virologic, and Clinical Outcomes: A Prospective Study of HIV-Infected Individuals in High-Income Countries
AU - Cain, Lauren E.
AU - Phillips, Andrew
AU - Olson, Ashley
AU - Sabin, Caroline
AU - Jose, Sophie
AU - Justice, Amy
AU - Tate, Janet
AU - Logan, Roger
AU - Robins, James M.
AU - Sterne, Jonathan A. C.
AU - van Sighem, Ard
AU - Reiss, Peter
AU - Young, James
AU - Fehr, Jan
AU - Touloumi, Giota
AU - Paparizos, Vasilis
AU - Esteve, Anna
AU - Casabona, Jordi
AU - Monge, Susana
AU - Moreno, Santiago
AU - Seng, Rémonie
AU - Meyer, Laurence
AU - Pérez-Hoyos, Santiago
AU - Muga, Roberto
AU - Dabis, François
AU - Vandenhende, Marie-Anne
AU - Abgrall, Sophie
AU - Costagliola, Dominique
AU - Hernán, Miguel A.
AU - AUTHOR GROUP
AU - Ainsworth, Jonathan
AU - Anderson, Jane
AU - Babiker, Abdel
AU - Delpech, Valerie
AU - Gras, L. A. J.
AU - Prins, J. M.
AU - Kuijpers, T. W.
AU - Scherpbier, H. J.
AU - van der Meer, J. T. M.
AU - Wit, F. W. M. N.
AU - Godfried, M. H.
AU - van der Poll, T.
AU - Nellen, F. J. B.
AU - Lange, J. M. A.
AU - Geerlings, S. E.
AU - van Vugt, M.
AU - Pajkrt, D.
AU - Bos, J. C.
AU - van der Valk, M.
AU - Grijsen, M. L.
AU - Wiersinga, W. J.
PY - 2015
Y1 - 2015
N2 - Background. Current clinical guidelines consider regimens consisting of either ritonavir-boosted atazanavir or ritonavir-boosted lopinavir and a nucleoside reverse transcriptase inhibitor (NRTI) backbone among their recommended and alternative first-line antiretroviral regimens. However, these guidelines are based on limited evidence from randomized clinical trials and clinical experience. Methods. We compared these regimens with respect to clinical, immunologic, and virologic outcomes using data from prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States in the HIV-CAUSAL Collaboration, 2004-2013. Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started a lopinavir or an atazanavir regimen. We estimated the 'intention-to-treat' effect for atazanavir vs lopinavir regimens on each of the outcomes. Results. A total of 6668 individuals started a lopinavir regimen (213 deaths, 457 AIDS-defining illnesses or deaths), and 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths). The adjusted intention-to-treat hazard ratios for atazanavir vs lopinavir regimens were 0.70 (95% confidence interval [CI],.53-.91) for death, 0.67 (95% CI,.55-.82) for AIDS-defining illness or death, and 0.91 (95% CI,.84-.99) for virologic failure at 12 months. The mean 12-month increase in CD4 count was 8.15 (95% CI, -.13 to 16.43) cells/mu L higher in the atazanavir group. Estimates differed by NRTI backbone. Conclusions. Our estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a greater 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for atazanavir compared with lopinavir regimens
AB - Background. Current clinical guidelines consider regimens consisting of either ritonavir-boosted atazanavir or ritonavir-boosted lopinavir and a nucleoside reverse transcriptase inhibitor (NRTI) backbone among their recommended and alternative first-line antiretroviral regimens. However, these guidelines are based on limited evidence from randomized clinical trials and clinical experience. Methods. We compared these regimens with respect to clinical, immunologic, and virologic outcomes using data from prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States in the HIV-CAUSAL Collaboration, 2004-2013. Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started a lopinavir or an atazanavir regimen. We estimated the 'intention-to-treat' effect for atazanavir vs lopinavir regimens on each of the outcomes. Results. A total of 6668 individuals started a lopinavir regimen (213 deaths, 457 AIDS-defining illnesses or deaths), and 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths). The adjusted intention-to-treat hazard ratios for atazanavir vs lopinavir regimens were 0.70 (95% confidence interval [CI],.53-.91) for death, 0.67 (95% CI,.55-.82) for AIDS-defining illness or death, and 0.91 (95% CI,.84-.99) for virologic failure at 12 months. The mean 12-month increase in CD4 count was 8.15 (95% CI, -.13 to 16.43) cells/mu L higher in the atazanavir group. Estimates differed by NRTI backbone. Conclusions. Our estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a greater 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for atazanavir compared with lopinavir regimens
U2 - https://doi.org/10.1093/cid/ciu1167
DO - https://doi.org/10.1093/cid/ciu1167
M3 - Article
C2 - 25567330
SN - 1058-4838
VL - 60
SP - 1262
EP - 1268
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -