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Comparative Study
. 2017 Apr 11;17(1):266.
doi: 10.1186/s12879-017-2379-8.

Comparison of atazanavir/ritonavir and darunavir/ritonavir based antiretroviral therapy for antiretroviral naïve patients

Tony Antoniou  1   2   3 , Leah Szadkowski  4 , Sharon Walmsley  5   4 , Curtis Cooper  6 , Ann N Burchell  7   8   5 , Ahmed M Bayoumi  7   5 , Julio S G Montaner  9   10 , Mona Loutfy  5   11   12 , Marina B Klein  13 , Nima Machouf  14 , Christos Tsoukas  13 , Alexander Wong  15 , Robert S Hogg  9   16 , Janet Raboud  5   4 ; Canadian Observational Cohort (CANOC) collaboration
Collaborators, Affiliations
Comparative Study

Comparison of atazanavir/ritonavir and darunavir/ritonavir based antiretroviral therapy for antiretroviral naïve patients

Tony Antoniou et al. BMC Infect Dis. .

Abstract

Background: Atazanavir/ritonavir and darunavir/ritonavir are common protease inhibitor-based regimens for treating patients with HIV. Studies comparing these drugs in clinical practice are lacking.

Methods: We conducted a retrospective cohort study of antiretroviral naïve participants in the Canadian Observational Cohort (CANOC) collaboration initiating atazanavir/ritonavir- or darunavir/ritonavir-based treatment. We used separate Fine and Gray competing risk regression models to compare times to regimen failure (composite of virologic failure or discontinuation for any reason). Additional endpoints included virologic failure, discontinuation due to virologic failure, discontinuation for other reasons, and virologic suppression.

Results: We studied 222 patients treated with darunavir/ritonavir and 1791 patients treated with atazanavir/ritonavir. Following multivariable adjustment, there was no difference between darunavir/ritonavir and atazanavir-ritonavir in the risk of regimen failure (adjusted hazard ratio 0.76, 95% CI 0.56 to 1.03) Darunavir/ritonavir-treated patients were at lower risk of virologic failure relative to atazanavir/ritonavir treated patients (aHR 0.50, 95% CI 0.28 to 0.91), findings driven largely by high rates of virologic failure among atazanavir/ritonavir-treated patients in the province of British Columbia. Of 108 discontinuations due to virologic failure, all occurred in patients starting atazanavir/ritonavir. There was no difference between regimens in time to discontinuation for reasons other than virologic failure (aHR 0.93; 95% CI 0.65 to 1.33) or virologic suppression (aHR 0.99, 95% CI 0.82 to 1.21).

Conclusions: The risk of regimen failure was similar between patients treated with darunavir/ritonavir and atazanavir/ritonavir. Although darunavir/ritonavir was associated with a lower risk of virologic failure relative to atazanavir/ritonavir, this difference varied substantially by Canadian province and likely reflects regional variation in prescribing practices and patient characteristics.

Keywords: Antiretroviral therapy; Atazanavir; Darunavir; HIV; Protease inhibitor.

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Figures

Fig. 1
Fig. 1
Cumulative incidence functions of time to events and competing risks
See this image and copyright information in PMC

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