Use of non-boosted atazanavir in clinical practice


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Abstract

The paper gives the results of using non-boosted atazanavir (ATV) in clinical trials and real clinical practice. Comparison of regimens including boosted and non-boosted ATV has indicated their equally high efficacy, but a better safety profile when the drug is used without ritonavir. Despite the elevated levels of unconjugated bilirubin in a number of patients taking ATV, jaundice develops in only 10% of patients, transaminase levels do not change and only 1-2% of patients need the drug to be discontinued because of hyperbilirubinemia (HBR). The predictors of its development, which are associated with both the characteristics of a patient (UGT1A1 deficiency) and with the pharmacokinetics of the drug, are identified. Several trials (NCT00440947, ARIES, and ASSURE) have shown that changing boosted ATV to non-boosted one decreases by more than twice the risk of not only HBR, but also any side effects, by altering pharmacokinetics and reducing the plasma concentration of the drug. The paper gives the results of several studies where non-boosted ATV has been used to simplify ATV regimens. After switching patients with sustained virologic suppression to the simplified regimen, there was a reduction in the daily number of taken tablets, a significant improvement in lipid parameters, and a decrease in the incidence of HBR with the equivalent efficiency of regimens and the low probability of treatment failure.

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About the authors

V. G Kanestri

Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare; Bristol-Mayer Squibb

Email: kanestry@hivrussia.net

M. V Yagodkin

Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare; Bristol-Mayer Squibb

Email: maxim.yagodkin@bms.com

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