Short-term safety of atazanavir/ritonavir-based second line treatment in Zambia

Atazanavir/ritonavir (ATV/r) was well tolerated in a Zambian cohort according to data presented at 8th INTEREST.

The Zambian HIV treatment programme introduced ATV/r as an alternative second-line protease inhibitor to lopinavir/ritonavir (LPV/r) in 2013. There are currently limited data describing the use of ATV/r-based regimens in sub-Saharan Africa.

Mpande Mukumbwa-Mwenechanya from the Centre for Infectious Disease Research in Zambia showed findings from an evaluation of adults who started ATV/r-based second-line ART at the University Teaching Hospital in Lusaka between November 2012 and February 2014. The investigators used multivariable logistic regression to assess potential risk factors – age, sex and transaminases – for hyperbilirubinaemia.

The investigators found, of 103 patients receiving an ATV/r-based regimen with evaluable data, 44 (43%) had no prior exposure to LPV/r and 59 (57%) were switched to ATV/r because of suspected LPV/r-related side effects (gastrointestinal intolerance and hyperlipidaemia).

The participants were similar in both treatment groups: median of 42.5 years old and had been taking ATV/r for a median of 7.5 months (IQR 6-11) and just over a third were men.

The majority reported no side effects (n=90, 87%). The participants most commonly reported yellow eyes (n= 8, 8%). Hyperbilirubinaemia was the most common adverse event overall (n= 19, 18%). The range was 27.5 to 141 umol/L and it was not associated with age, sex or elevated transaminases: HR 1.02 (95% CI 0.98-1.06), HR 0.82 (95% C: 0.31-2.14), HR 0.92 (95% CI 0.41-1.87) respectively. Only one participant stopped his ATV/r-based regimen due to severe abdominal pain.

Comment

Although a small and short-term study these data are reassuring. The LPV/r monopoly is quite entrenched for second-line in low-income settings, despite generic co-formulated ATV/r being available and generally considered to be a more tolerable protease inhibitor.

Mwenechanya MM et al. Short-term safety profile of atazanavir/ritonavir-based second-line therapy among HIV-infected adults in Zambia. 8th International Workshop on HIV Treatment, Pathogenesis and Prevention Research in Resource-Poor Settings (INTEREST). 5-6 May 2014. Lusaka, Zambia. Oral abstract: O_04.
http://regist2.virology-education.com/2014/8INTEREST/40_Mpande.pdf