Immunological and Virological Outcomes of Patients Switched from LPV/r to ATV Ir-Containing Second- Line Regimens

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Akanmu, A.S.
Adeyemo, T.
Lesi, F.
Bello, F.O.
Okwuegbuna, K.
Oloko, K.
Awolola, A.
Ogunsola, F.T.
Okonkwo, P.
Kanki, P.J.
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Background: Atazanavir/ritonavir (ATV Ir) recently became the preferred protease inhibitor (PI) for use in Nigeria since it is dosed once daily, which may improve treatment adherence and has fewer side effects than lopinavir/ritonavir (LPV/r) - the most widely available PI in resource-limited settings. We, therefore, aimed to evaluate the immunologic and virologic effects of switching patients to an A TV Ir-containing regimen. Methods: In a large antiretroviral treatment programme at the Lagos University Teaching Hospital in Nigeria, 400 patients were switched to ATV/r-based second-line ART. We conducted a retrospective evaluation of immunologic and virologic outcomes following 24 months on the ATV/r regimens. Results: Of the 400 patients switched to an ATV/r containing regimen, 255 were virologically suppressed on LPV/r prior to switch, I 07 were switched due to failure on a first-line regimen, 28 were on saquinavir/ritonavir (SQV /r)-based regimen, while IO were unintentionally switched while non-suppressed on a LPV/r-based regimen. Demonstrable and sustained immunological responses were documented as the median (IQR) CD4+ cell count increased steadily from 466 (323) cells/mm3 at the time of switch to 490 (346) cells/mrrr' at 6 months, and 504 (360) cells/mm3 at 24 months. Of 99 patients evaluated 12 months after ATV/r switch, 2 (2%) had detectable viral load (VL). None of the 26 (0%) in this group evaluated at 24 months had detectable viral load. In a comparison group of 576 patients who were maintained on LPV/r-based second line regimens, 359 (62.3%) had undetectable viral loads. Of 31 8 patients with VL data 24 months later, 25 (7.9%) had detectable VL. There was no significant difference between the proportion of patients maintained on LPV/r (7.9%) and those switched to ATV/r (0%) in the development of virologic failure after 24 months of follow-up. Conclusion: Among patients that were switched to ATV/r-containing regimens, we found improvements .in immunological responses and no increase in risk ofvirologic failure.
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Africa , Antiretroviral therapy , Hiv/aids , Protease-inhibitors , Research Subject Categories::MEDICINE::Microbiology, immunology, infectious diseases
Akanmu, A.S, Adeyemo, T, Lesi, F, Bello, F.O, Okwuegbuna, K, Oloko, K, Awolola, A, Ogunsola, F.T, Okonkwo P. and Kanki P.J. (2015). Immunological and Virological Outcomes of Patients Switched from LPV/r to ATV/r-Containing Second- Line Regimens Current HIV Research, 13(3): 176-183 DOI:10.2174/1570162X1303150506181434.