Boosted lopinavir- versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: a prospective study of HIV-infected individuals in high-income countries. Clinical Infectious Diseases
Cain et al. on behalf of the HIV-CAUSAL Collaboration aimed to provide evidence on clinical outcomes among patients who started a first-line regimen consisting of either ritonavir-boosted lopinavir or ritonavir-boosted atazanavir with an NRTI backbone. Compared with lopinavir, the hazard ratio for atazanavir was 0.70 for death, 0.67 for AIDS or death and 0.91 for virologic failure. Compared with lopinavir, the mean change in CD4 cell count for atazanavir was 8.15 cells/µl.
In conclusion, the authors estimated a 30% mortality reduction for atazanavir vs lopinavir and found that atazanavir had a beneficial but modest effect on immunologic and virologic outcomes. Future studies need to consider the effects of lopinavir and atazanavir on other clinical outcomes including non-AIDS-defining illnesses, when paired with specific backbones.