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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.
J Antimicrob Chemother. 2008 Jan; 61(1):200-5.JA

Abstract

BACKGROUND

Atazanavir seems to be a protease inhibitor (PI) with a more favourable metabolic profile. Information regarding the potential benefit of replacing lopinavir/ritonavir by atazanavir in HIV-infected patients with prolonged viral suppression is scarce. If proved, this strategy could be particularly attractive for the subset of patients with greater cardiovascular risk.

METHODS

SLOAT was a prospective, open, comparative trial in which patients receiving lopinavir/ritonavir-based regimens and having undetectable plasma HIV-RNA for longer than 24 weeks were randomized to continue on the same therapy or switch to atazanavir. Outcomes in viral rebound, CD4 counts, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and glucose were compared in both groups of patients at 48 weeks of follow-up.

RESULTS

A total of 189 patients were recruited and took at least the first dose of the assigned treatment arm. Overall, 102 switched to atazanavir (49 on 400 mg once daily, and 53 on 300 mg plus 100 mg of ritonavir once daily due to concomitant tenofovir use) and 87 continued on lopinavir/ritonavir. All patients received the PI along with two nucleoside analogues. Virological failure occurred in 12 patients switched to atazanavir and 9 continuing on lopinavir/ritonavir. A reduction (P < 0.001) in median total cholesterol (-19 mg/dL) and triglycerides (-80 mg/dL) was observed after 48 weeks of atazanavir switching, whereas no significant changes occurred in the lopinavir/ritonavir arm. Greater reductions in total cholesterol and triglycerides were seen in patients switched to atazanavir without ritonavir boosting.

CONCLUSIONS

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

Authors+Show Affiliations

Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain. vsoriano@dragonet.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17999977

Citation

Soriano, Vincent, et al. "Efficacy and Safety of Replacing Lopinavir With Atazanavir in HIV-infected Patients With Undetectable Plasma Viraemia: Final Results of the SLOAT Trial." The Journal of Antimicrobial Chemotherapy, vol. 61, no. 1, 2008, pp. 200-5.
Soriano V, García-Gasco P, Vispo E, et al. Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial. J Antimicrob Chemother. 2008;61(1):200-5.
Soriano, V., García-Gasco, P., Vispo, E., Ruiz-Sancho, A., Blanco, F., Martín-Carbonero, L., Rodríguez-Novoa, S., Morello, J., de Mendoza, C., Rivas, P., Barreiro, P., & González-Lahoz, J. (2008). Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial. The Journal of Antimicrobial Chemotherapy, 61(1), 200-5.
Soriano V, et al. Efficacy and Safety of Replacing Lopinavir With Atazanavir in HIV-infected Patients With Undetectable Plasma Viraemia: Final Results of the SLOAT Trial. J Antimicrob Chemother. 2008;61(1):200-5. PubMed PMID: 17999977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of replacing lopinavir with atazanavir in HIV-infected patients with undetectable plasma viraemia: final results of the SLOAT trial. AU - Soriano,Vincent, AU - García-Gasco,Pilar, AU - Vispo,Eugenia, AU - Ruiz-Sancho,Andrés, AU - Blanco,Francisco, AU - Martín-Carbonero,Luz, AU - Rodríguez-Novoa,Sonia, AU - Morello,Judit, AU - de Mendoza,Carmen, AU - Rivas,Pablo, AU - Barreiro,Pablo, AU - González-Lahoz,Juan, Y1 - 2007/11/13/ PY - 2007/11/15/pubmed PY - 2008/2/29/medline PY - 2007/11/15/entrez SP - 200 EP - 5 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 61 IS - 1 N2 - BACKGROUND: Atazanavir seems to be a protease inhibitor (PI) with a more favourable metabolic profile. Information regarding the potential benefit of replacing lopinavir/ritonavir by atazanavir in HIV-infected patients with prolonged viral suppression is scarce. If proved, this strategy could be particularly attractive for the subset of patients with greater cardiovascular risk. METHODS: SLOAT was a prospective, open, comparative trial in which patients receiving lopinavir/ritonavir-based regimens and having undetectable plasma HIV-RNA for longer than 24 weeks were randomized to continue on the same therapy or switch to atazanavir. Outcomes in viral rebound, CD4 counts, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and glucose were compared in both groups of patients at 48 weeks of follow-up. RESULTS: A total of 189 patients were recruited and took at least the first dose of the assigned treatment arm. Overall, 102 switched to atazanavir (49 on 400 mg once daily, and 53 on 300 mg plus 100 mg of ritonavir once daily due to concomitant tenofovir use) and 87 continued on lopinavir/ritonavir. All patients received the PI along with two nucleoside analogues. Virological failure occurred in 12 patients switched to atazanavir and 9 continuing on lopinavir/ritonavir. A reduction (P < 0.001) in median total cholesterol (-19 mg/dL) and triglycerides (-80 mg/dL) was observed after 48 weeks of atazanavir switching, whereas no significant changes occurred in the lopinavir/ritonavir arm. Greater reductions in total cholesterol and triglycerides were seen in patients switched to atazanavir without ritonavir boosting. CONCLUSIONS: The replacement of lopinavir/ritonavir by atazanavir provides an overall significant reduction in total cholesterol and triglycerides, without increased risk of virological failure. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/17999977/Efficacy_and_safety_of_replacing_lopinavir_with_atazanavir_in_HIV_infected_patients_with_undetectable_plasma_viraemia:_final_results_of_the_SLOAT_trial_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkm413 DB - PRIME DP - Unbound Medicine ER -