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Session 147 Poster Abstracts
Clinical Studies of Hyperlipidemia, Fat Redistribution, and Glucose Metabolism
Thursday, 1:30 - 3:30 pm
Hall B


850    
Effects of Switching to Ritonavir-boosted Atazanavir on HIV-infected Patients Receiving Antiretroviral Therapy with Hyperlipidemia.
E Martinez*1, C Azuaje2, A Antela3, A Rivero4, F Lozano5, E Deig6, D Fuster7, O Serrano8, and BMS study 900 ATV Early Access Program-Spain
1Hosp Clin, Barcelona, Spain; 2Hosp Vall d'Hebron, Barcelona, Spain; 3Hosp Ramon y Cajal, Madrid, Spain; 4Hosp Reina Sofia, Cordoba, Spain; 5Hospital de Valme, Sevilla, Spain; 6Hosp de Granollers, Barcelona, Spain; 7Hosp Germans Trias i Pujol, Barcelona, Spain; and 8Bristol-Myers Squibb, Madrid, Spain

Background:  Atazanavir (ATV), even when boosted with ritonavir (RTV) has favorable lipids (total cholesterol, LDL-cholesterol, and triglycerides) compared with twice-daily lopinavir/ritonavir (LPV/r) which result in significantly less usage of lipid lowering therapy. However, no ATV study has been reported that describes lipid improvement in hyperlipidemia patients.

Methods:  Treated HIV-infected patients with hyperlipidemia defined by at least 1 of the following:  fasting triglycerides >500 mg/dL, total cholesterol >200 mg/dL, or LDL-cholesterol (LDL) > 130 mg/dL for at least the previous 3 months were offered to receive antiretroviral therapy containing RTV-boosted ATV as part of BMS Study 900 Early Access Program (EAP). Clinical and fasting laboratory data were collected at baseline and at 1, 3, and 6 months. Pre-entry stable lipid-lowering therapies could be maintained but new prescriptions or dose modifications were not allowed during the study.

Results:  At the time of this analysis, of 162 (77% men) patients recruited in 35 centers, 41 (25%) completed at least 6 months of follow-up. Median (IQR) age was 40 (4) years. At baseline, 45% had < 500 copies HIV-1 RNA/mL. The drugs most frequently discontinued on starting RTV-boosted ATV were LPV/r (34%) and other boosted protease inhibitors (14%). The drugs most frequently administered with RTV-boosted ATV were tenofovir (56%), didanosine (44%), and lamivudine (26%). Only 7 patients (4.3%) discontinued RTV-boosted ATV during the follow-up, 1 (0,6%) due to jaundice. At month 6, 58% had < 500 copies HIV-1 RNA/mL. Median (IQR) baseline values of triglycerides, total cholesterol, LDL, and HDL were 289 (411), 225 (48), 138 (44), and 39 (15) mg/dL. Median lipid changes from baseline to month 6 were:  –18% in triglycerides (p < 0.0001), –12% in total cholesterol (p < 0.0001), –10% in LDL (p < 0.0001), and –3% in HDL (p > 0.05). The proportions of patients with:  triglycerides > 500 mg/dL decreased from 33% to 10% (p < 0.0001), total cholesterol > 200 mg/dL from 90% to 51% (p < 0.0001), and LDL > 130 mg/dL from 65% to 36% (p < 0.0001).

Conclusions:  Switching to antiretroviral therapy containing RTV-boosted ATV in HIV-infected patients with persistent hyperlipidemia was associated with significant improvements in plasma lipids without an increased risk of virologic failure.

Keywords: atazanavir/ritonavir; hyperlipidemia; management