Atazanavir/ritonavir with lamivudine as maintenance therapy in virologically suppressed HIV-infected patients: 96 week outcomes of a randomized trial

Abstract

In this randomized study, a treatment switch to atazanavir/ritonavir + lamivudine was superior over the continuation of atazanavir/ritonavir + 2NRTI in virologically suppressed patients, with a sustained benefit in terms of improved renal function and bone mineral density.

The management of treatment-experienced HIV patients (including virologic failure and switches)

“…Boosted PI + 3TC: switch to LPV/ritonavir + 3TC, 83 boosted ATV + 3TC, 84 or boosted DRV + 3TC, 85 have also been shown to be safe and effective. These could also be considered if there is a need to avoid NRTI exposure.…”

No Significant Changes to Residual Viremia After Switch to Dolutegravir and Lamivudine in a Randomized Trial

“…In a study of switching suppressed patients to raltegravir (RAL) plus maraviroc (MVC), increased virologic failure was observed despite preswitch assessment of viral tropism [2]. By contrast, switching to DTG+rilipvirine (RPV) [14] or a boosted PI+3TC [15, 16] has been a successful strategy. In addition, no significant changes in levels of systemic inflammation [17] or differences in HIV DNA decline [18] were observed.…”

“…The use of DTG+3TC as a maintenance regimen likely has several benefits, including decreasing costs [21, 22] and avoidance of side effects associated with abacavir or tenofovir. For example, the switch to a 2-drug therapy has been reported to improve renal function and bone mineral density when tenofovir disoproxil fumarate is avoided [15], and improvements in immune function and metabolic markers have also been found with decreased nucleos(t)ide reverse transcriptase (NRTI) exposure [21, 23]. It is important to note that the ASPIRE trial excluded individuals with any history of NRTI genotypic resistance mutations, especially in light of a recent report showing that a history of M184V resistance was associated with an increased probability of viral blips in those switching to DTG+3TC [24].…”

Current antiretroviral therapies and future trends in management of HIV-1 infection

“…The combination of a boosted PI/r and 3TC has been explored in several studies (17,(31)(32)(33)(34). The MOBIDIP study (17) (n=265) was a randomized, multicenter superiority trial conducted in Sub-Saharan Africa, comparing maintenance therapy with a boosted PI (LPV/r or DRV/r) to dual therapy with 3TC plus either boosted PI.…”

“…Boosted ATV has been studied in combination with 3TC in the SALT (31) (n=285) and ATLAS-M trials (32) (n=266) with equally encouraging results. Both studies demonstrated that switching from triple therapy to ATV/r plus 3TC succeeding in maintaining virologic suppression, and the ATLAS-M study showed that switching from a TDF-containing regimen was associated with improved renal parameters (32).…”