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Efficacy and safety of atazanavir/ritonavir-based antiretroviral therapy for HIV-1 infected subjects: a systematic review and meta-analysis

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Abstract

Atazanavir (ATZ) is a well-tolerated protease inhibitor that can be boosted with ritonavir (r) to treat infection with resistant strains of human immunodeficiency virus 1 (HIV-1). The aim of this meta-analysis was to compare the efficacy, safety, and metabolic effects of ATZ/r regimen versus commonly used antiretroviral drugs such as lopinavir (LPV) and darunavir (DRV) in HIV-1-infected patients. We searched PubMed, Scopus, Embase and Cochrane CENTRAL, using relevant keywords. Data were extracted from eligible randomized trials and pooled as risk ratios (RR) or standardized mean differences (SMD) in a meta-analysis model using RevMan software. Nine randomized controlled trials (RCTs) (3292 patients) were eligible for the final analysis. After 96 weeks of treatment, the pooled effect estimate did not favor either ATZ/r or LPV/r in terms of virological failure rate (RR 1.11, 95% CI [0.74, 1.66]). However, ATZ/r was marginally superior to LPV/r in terms of increasing the proportion of patients with HIV RNA <50 copies/ml (RR 1.09, 95% CI [1.01, 1.17]). The pooled effect estimate did not favor ATZ/r over DRV/r regarding the change in plasma levels of total cholesterol, triglycerides, or high-density lipoprotein at 24, 48, and 96 weeks. Moreover, no significant difference was found between the two regimens (ATZ/r and DRV/r) in terms of change in visceral (SMD -0.06, 95%CI [-0.33, 0.21]) or subcutaneous adipose tissue (SMD 0.12, 95% CI [-0.15, 0.39]). The ATZ/r regimen was generally as effective and well-tolerated as the LPV/r regimen for the treatment of HIV-1 patients. Compared to the DRV/r regimen, ATZ/r has no favorable effect on the plasma lipid profile or adipose tissue distribution.

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Acknowledgements

The authors would like to thank their colleagues in the Medical Research Group of Egypt (MRGE) and NovaMed Medical Research Association for their continuos support.

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  1. Amr Menshawy and Ammar Ismail contributed equally to this manuscript.

Authors and Affiliations

  1. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Amr Menshawy, Ammar Ismail, Esraa Menshawy, Ahmed Elmaraezy, Mohamed Abdel-Maboud & Attia Attia

  2. Al-Azhar Medical Students’ Association (AMSA), Cairo, Egypt

    Amr Menshawy, Ammar Ismail, Esraa Menshawy, Ahmed Elmaraezy & Mohamed Abdel-Maboud

  3. Medical Research Group of Egypt, Cairo, Egypt

    Amr Menshawy, Ammar Ismail, Abdelrahman Ibrahim Abushouk, Hussien Ahmed, Esraa Menshawy, Ahmed Elmaraezy, Mohamed Gadelkarim, Mohamed Abdel-Maboud, Attia Attia & Ahmed Negida

  4. NovaMed Medical Research Association, Cairo, Egypt

    Ammar Ismail, Abdelrahman Ibrahim Abushouk & Ahmed Elmaraezy

  5. Faculty of Medicine, Ain Shams University, Ramsis st, Abbasia, Cairo, 11591, Egypt

    Abdelrahman Ibrahim Abushouk

  6. Faculty of Medicine, Zagazig University, El-Sharkia, Egypt

    Hussien Ahmed & Ahmed Negida

  7. Student Research Unit, Zagazig University, El-Sharkia, Egypt

    Hussien Ahmed & Ahmed Negida

  8. Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Mohamed Gadelkarim

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  1. Amr Menshawy
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Correspondence to Abdelrahman Ibrahim Abushouk.

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Menshawy, A., Ismail, A., Abushouk, A.I. et al. Efficacy and safety of atazanavir/ritonavir-based antiretroviral therapy for HIV-1 infected subjects: a systematic review and meta-analysis. Arch Virol 162, 2181–2190 (2017). https://doi.org/10.1007/s00705-017-3346-9

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