Switching to a two-drug regimen of dolutegravir and unboosted atazanavir may be an option for people who cannot simplify to another two-drug regimen, a retrospective study published in AIDS found.
The Italian study involved 151 virologically suppressed participants who were switched to the two-drug regimen. Median age was 53 years and median time on antiretroviral therapy was 15 years. Cardiovascular concerns prompted the treatment change in 25% of participants.
Overall, total cholesterol, triglycerides, and fasting glucose decreased at slopes of ‑0.65mg/dl/month, ‑1.64.mg/dl/month, and ‑0.55mg/dl/month, respectively, on the new regimen, while CD4 cell counts remained stable.
Two virologic failures and 13 treatment failures -- including 10 discontinuations for adverse events -- occurred after the switch.
The antiviral activity and higher genetic barrier of dolutegravir may explain the greater efficacy seen in this trial compared to studies of a two-drug raltegravir (Isentress) and unboosted atazanavir regimen, study authors hypothesized. Results show that a dolutegravir + unboosted atazanavir treatment could be used to spare both boosting agents and reverse transcriptase inhibitors in patients were this is warranted, they concluded.