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Observational Study
. 2015 Apr 15;60(8):1262-8.
doi: 10.1093/cid/ciu1167. Epub 2015 Jan 6.

Boosted lopinavir- versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: a prospective study of HIV-infected individuals in high-income countries

HIV-CAUSAL Collaboration; Lauren E Cain, Andrew Phillips, Ashley Olson, Caroline Sabin, Sophie Jose, Amy Justice, Janet Tate, Roger Logan, James M Robins, Jonathan A C Sterne, Ard van Sighem, Peter Reiss, James Young, Jan Fehr, Giota Touloumi, Vasilis Paparizos, Anna Esteve, Jordi Casabona, Susana Monge, Santiago Moreno, Rémonie Seng, Laurence Meyer, Santiago Pérez-Hoyos, Roberto Muga, François Dabis, Marie-Anne Vandenhende, Sophie Abgrall, Dominique Costagliola, Miguel A Hernán
Collaborators
Observational Study

Boosted lopinavir- versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: a prospective study of HIV-infected individuals in high-income countries

HIV-CAUSAL Collaboration et al. Clin Infect Dis. .

Abstract

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/µL 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.

Keywords: HIV; atazanavir; lopinavir; mortality; observational studies.

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Figures

Figure 1.
Figure 1.
Survival (left) and AIDS-free survival (right) for atazanavir vs lopinavir, HIV-CAUSAL Collaboration, 2004–2013. The curves are standardized by the baseline covariates listed in the Table 2 footnotes.
See this image and copyright information in PMC

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