Outcomes of switch to atazanavir-containing combination antiretroviral therapy in HIV-1-infected patients with hyperlipidemia.

BACKGROUND Prolonged exposure to combination antiretroviral therapy (CART) may result in hyperlipidemia and other metabolic complications. This study aimed to evaluate the clinical, virologic, and immunologic outcomes in HIV-infected patients with hyperlipidemia whose CART was switched to atazanavir-containing antiretroviral regimens. METHODS In this 48-week prospective, observational study that was conducted at designated hospitals for HIV care in Taiwan, HIV-infected patients aged 18 years or older who had developed hyperlipidemia after receiving CART that did not contain atazanavir were enrolled. Antiretroviral regimens were switched to regimens containing two nucleoside reverse-transcriptase inhibitors plus atazanavir 400 mg once daily or atazanavir 300 mg boosted with ritonavir 100 mg once daily. The lipid profiles, including total triglycerides, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, CD4+ lymphocyte counts, and plasma HIV RNA load were determined every 3 months. RESULTS Sixty-six patients with hyperlipidemia were enrolled. At the end of the study, triglyceride levels declined by 49.0% (p = 0.0002) and total cholesterol levels by 18.1% from baseline (p < 0.0001), whereas there were no significant changes observed for low-density lipoprotein- and high-density lipoprotein-cholesterol levels. Mean CD4 lymphocyte count increased from 465 cells/μL at baseline to 498 cells/μL at the end of the study, whereas the proportion of patients with undetectable plasma HIV RNA load increased from 73.1% to 81.7%. The regimens were well tolerated. CONCLUSIONS Switch to atazanavir-containing regimens that were well tolerated resulted in significant improvement of hyperlipidemia and maintenance of clinical, immunologic, and virologic responses to CART.