Efficacy and Safety of Atazanavir plus Raltegravir Dual Therapy in Treatment-Experienced HIV-1 Infected Patients

摘要

Background: Atazanavir (ATV) plus raltegravir (RAL) is a non-traditional regimen which avoids ritonavir-associated toxicity and interactions and may be effective in patients resistant or intolerant to nucleoside reverse transcriptase inhibitor (NRTIs). Experience in treatment-experienced patients has been promising but data are limited. Objective: To evaluate the efficacy and safety of twice daily ATV/RAL in treatment-experienced patients. Methods: A retrospective review of HIV clinic patients between January 1, 2007 and June 31, 2014 was conducted. Patients on concomitant ritonavir or with less than 6 months follow-up were excluded. Efficacy and safety data at 24, 48 weeks and most recent follow-up were compiled. Results: Sixteen patients were included for analysis: median (range) age 48.5 (36-76) years, 14 (87%) male, 9 (56%) Caucasian, 11 (69%) men who have sex with men. Median duration of HIV infection was 21 (4-27) years, 4 (25%) had prior AIDS-defining illnesses. Patients received a median of 8.5 (3-14) prior antiretroviral regimens. All patients had pre-existing drug resistance (n= 14 NRTI, 11 non-NRTI, 2 protease inhibitor and 1 raltegravir). Baseline viral load (VL) was undetectable in 9 (56%) patients for a median of 72 (2-130) months prior to starting ATV/RAL; the median VL was 4.39 (1.96-5.2) log10 copies/mL for 7 (44%) patients at baseline. Baseline median CD4~+ was 223 (<10-1023) cells/mm~3, with median nadir of 104 (<10-697) cells/ mm~3. Reasons for initiating ATV/RAL included adverse reactions/tolerability (n=9), treatment failure (n=4), cost/convenience (n=2), and drug interactions (n=1). Median duration of follow-up was 23.9 (6.1-51.9) months. Fourteen (87.5 %) patients achieved and maintained virologic suppression. Two patients experienced virologic rebound due to treatment interruption/ nonadherence without development of new resistance mutations. The median increase in CD4~+ count was 143 cells/mm~3. No patients experienced serious medication-related adverse events. Conclusion: Atazanavir plus raltegravir is an effective, durable and safe regimen in treatment-experienced patients.