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Observational Study
. 2019 Mar 25;19(1):280.
doi: 10.1186/s12879-019-3907-5.

An observational study in an urban Ugandan clinic comparing virological outcomes of patients switched from first-line antiretroviral regimens to second-line regimens containing ritonavir-boosted atazanavir or ritonavir-boosted lopinavir

Eva Agnes Odongpiny Laker  1 , Maria Sarah Nabaggala  2 , Arvind Kaimal  2 , Damalie Nalwanga  2 , Barbara Castelnuovo  2 , Abdu Musubire  2 , Agnes Kiragga  2 , Mohammed Lamorde  2 , Rosalind Parkes- Ratanshi  2   3
Affiliations
Observational Study

An observational study in an urban Ugandan clinic comparing virological outcomes of patients switched from first-line antiretroviral regimens to second-line regimens containing ritonavir-boosted atazanavir or ritonavir-boosted lopinavir

Eva Agnes Odongpiny Laker et al. BMC Infect Dis. .

Abstract

Background: The World Health Organisation approved boosted atazanavir as a preferred second line protease inhibitor in 2010. This is as an alternative to the current boosted lopinavir. Atazanavir has a lower genetic barrier than lopinavir. We compared the virological outcomes of patients during the roll out of routine viral load monitoring, who had switched to boosted second- line regimens of either atazanavir or lopinavir.

Methods: This was a cross-sectional study involving adult patients at the Infectious Diseases Institute Kampala, Uganda started on a standard WHO recommended second-line regimen containing either boosted atazanavir or boosted lopinavir between 1 Dec 2014 and 31 July 2015.. Mantel -Haenszel chi square was used to test for the statistical significance of the odds of being suppressed (VL < 400 copies/ml) when on boosted atazanavir compared to boosted lopinavir after stratifying by duration on antiretroviral therapy (ART). Multivariate logistic regression analysis used to determine if the type of boosted protease inhibitor (bPI) was associated with virological outcome.

Results: Ninety (90) % on ATV/r and 83% on LPV/r had a VL less than 1000 copies/ml. The odds of being suppressed using the same viral load cut-off while on boosted atazanavir compared to boosted lopinavir was not statistically significant after stratifying for duration on ART (p = 0.09). In a multivariate analysis the type of bPI used was not a predictor of virological outcome (p = 0.60).

Conclusions: Patients using the WHO recommended second-line of boosted atazanavir have comparable virological suppression to those on boosted lopinavir.

Keywords: Atazanavir; First-line failure; Lopinavir; Second-line antiretroviral.

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Conflict of interest statement

Ethics approval and consent to participate

All routinely collected clinic data is approved for analysis and reporting by the Makerere University Faculty of Medicine, Research and Ethics committee (approval number: 120–2009) and Uganda National Council for Science and Technology (approval number: 45683) hence the need for consent was waived by an IRB.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Follow up status of patients ever started on boosted atazanavir and on boosted lopinavir at time of study
Fig. 2
Fig. 2
Percentage suppression with different viral load cutoffs in patients by duration on second line therapy at time of viral load (standard ATV/r versus LPV/r based second-line regimen)
See this image and copyright information in PMC

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