Virological efficacy and safety of antiretroviral therapy-switch to atazanavir-based regimen: a review of the literature.

INTRODUCTION: Patients on antiretroviral combination therapy, experiencing drug toxicity or inconvenience, require alternative options maintaining virological suppression. The protease inhibitor atazanavir is a promising candidate.

AREAS COVERED: Published studies exploring a switch to atazanavir-based regimens were systematically reviewed from medical databases and evaluated with regard to efficacy, safety, unboosted use, monotherapy, and hepatitis C coinfection. Randomized trials comparing a switch toward ritonavir-boosted atazanavir versus therapy continuation revealed for antiretroviral efficacy, lipid profiles, and glucose tolerance a similar outcome, if the comparator was lopinavir-ritonavir and better by trend for patients previously using nelfinavir/indinavir or subsequently switching to ritonavir-sparing atazanavir, whereas lipodystrophy was hardly improved. Most clinical chemistry markers improved, except for hyperbilirubinemia, but visible jaundice was rarely a discontinuation reason. ALT levels or glucose tolerance remained similar, or improved. Maintenance strategies including switch from boosted to unboosted atazanavir seemed to be very effective, especially if the regimen was tenofovir sparing; boosted PI monotherapy cannot be recommended to date. For HCV-genotype 1 coinfected individuals requiring treatment modification, atazanavir is the only protease inhibitor recommended for telaprevir coadministration.

EXPERT OPINION: Atazanavir-based antiretroviral triple therapy is a valuable and effective option for patients who need to switch from another stable protease inhibitor regimen for convenience or tolerability reasons.