Table 5.
Summary of lipid alterations among patients on atazanavir/ritonavir in clinical trials.
| Study | Intervention type | Patient type (n) | Lipid changes (%)† | Follow-up (weeks) | Ref. |
|---|---|---|---|---|---|
| ARIES | Single arm (ATV/r + ABC/3TC) | Naive (515) | TC increase: 31 LDL increase: 11 HDL increase: 10 TG increase: 34 |
36 | [74] |
|
| |||||
| BMS AI424–089 | Comparison (ATV/r vs ATV) | Naive (200) | ATV/r: TC increase: 24 LDL increase: 22 HDL increase: 9 TG increase: 14 |
48 | [64] |
| ATV: TC increase: 11 LDL increase: 16 HDL increase: 9 TG decrease: 15 |
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|
| |||||
| ACTG 5202 | Comparison (ATV/r vs EFV) | Naive (1867) | EFV consistently associated with significantly greater increase in fasting TC, LDL, and HDL compared with ATV/r regardless of NRTI backbone used TG also when paired with ABC/3TC Numbers not reported |
96 | [76] |
|
| |||||
| ARTEN | Comparison (ATV/r vs NVP) | Naive (569) | ATV/r: TC increase: 20 LDL increase: 11 HDL increase: 4 TG increase: 28 |
48 | [79] |
| NVP: TC increase: 24 LDL increase: 15 HDL increase: 10 TG decrease: 0.2 |
|||||
|
| |||||
| ALERT | Comparison (ATV/r vs FPV/r) | Naive (106) | ATV/r: TC increase: 15 LDL increase: 4 HDL increase: 11 TG increase: 7 |
48 | [73] |
| FPV/r: TC increase: 11 LDL increase: 4 HDL increase: 5 TG increase: 34 |
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|
| |||||
| CASTLE | Comparison (ATV/r vs LPV/r) | Naive (883) | ATV/r: TC increase: 12 LDL increase: 12 HDL increase: 27 TG increase: 13 |
48 | [71] |
| LPV/r: TC increase: 24 LDL increase: 15 HDL increase: 32 TG increase: 51 |
|||||
|
| |||||
| BMS AI424–045 | Comparison (ATV/r vs LPV/r) | Exp. (443) | ATV/r: TC decrease: 7 LDL decrease: 11 TG decrease: 2 |
96 | [69] |
| LPV/r: TC increase: 9 LDL increase: 1 TG increase: 30 |
|||||
|
| |||||
| Stanley et al. | Switch (LPV/r to ATV/r) | Hyperinsulinemia, and/or dyslipidemia, virologically suppressed (15) | TC decrease: 23 TG decrease: 182 |
24 | [106] |
|
| |||||
| ATAZIP | Switch (LPV/r to ATV/r) | Virologically suppressed (248) | TC decrease: 24 TG decrease: 53 |
96 | [104] |
|
| |||||
| SWAN | Switch (any PI to ATV or ATV/r) | Virologically suppressed (419) | Switch: TC decrease: 15 LDL decrease: 12 Non-HDL decrease:18 TG decrease: 33 |
48 | [103] |
| No switch: TC decrease: 3 LDL decrease: 5 Non-HDL decrease: 3 TG increase: 9 |
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|
| |||||
| Calza et al. | Switch (any PI to ATV/r) | Hyperlipidemia and virologically suppressed (89) | TG decrease: 15 TC decrease: 16 LDL decrease: 18 |
48 | [107] |
|
| |||||
| SLOAT | Switch (LPV/r to ATV/r or ATV) | Virologically suppressed (189) | Switch: TC decrease: 12 LDL increase: 4 HDL increase: 2 TG decrease: 38 |
48 | [105] |
| No Switch: TC decrease: 0.5 LDL decrease: 0.5 HDL increase: 1 TG decrease: 5 |
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|
| |||||
| SABAR | Switch (any boosted PI to ATZ/r) | Hyperlipidemia and virologically suppressed (50) | Switch: TC decrease: 25 LDL decrease: 6 TG decrease: 58 |
24 | [102] |
| No Switch: TC increase: 2 LDL increase: 4 TG increase: 4 |
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Mean change in mg/dl unless otherwise noted.
ABC/3TC: Abacavir/lamivudine; ALERT: Atazanavir or Lexiva with Ritonavir and Truvada; ARIES: Atazanavir Ritonavir Induction with Epzicom Study; ARTEN: Atazanavir/Ritonavir on a Background of Tenofovir and Emtricitabine (Truvada) Versus Nevirapine; ATV: Atazanavir; ATV/r: Atazanavir/ritonavir; BMS: Bristol-Myers Squibb; CASTLE: Comparison of Atazanavir/Ritonavir in Naive Subjects in Combination with Tenofovir/Emtricitabine Versus Lopinavir/Ritonavir in Combination with Tenofovir/Emtricitabine to Assess Safety and Efficacy; EFV: Efavirenz; Exp: ART-experienced; FPV/r: Fosamprenavir/r; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LPV/r: Lopinavir/r; Naive: ART-Naive; NRTI: Nucleoside reverse transcriptase inhibitors; NVP: Nevirapine; PI: Protease inhibitor; SABAR: Switch to Atazanavir and Brachial Artery Study; TC: Total cholesterol; TG: Triglycerides.