Lipid profiles in HIV-infected adults receiving atazanavir and atazanavir/ritonavir: systematic review and meta-analysis of randomized controlled trials

Carey, Dianne, Amin, Janaki, Boyd, Mark, Petoumenos, Kathy and Emery, Sean (2010) Lipid profiles in HIV-infected adults receiving atazanavir and atazanavir/ritonavir: systematic review and meta-analysis of randomized controlled trials. Journal of Antimicrobial Chemotherapy, 65 9: 1878-1888. doi:10.1093/jac/dkq231


Author Carey, Dianne
Amin, Janaki
Boyd, Mark
Petoumenos, Kathy
Emery, Sean
Title Lipid profiles in HIV-infected adults receiving atazanavir and atazanavir/ritonavir: systematic review and meta-analysis of randomized controlled trials
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
1460-2091
Publication date 2010-06-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/jac/dkq231
Open Access Status Not yet assessed
Volume 65
Issue 9
Start page 1878
End page 1888
Total pages 11
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Objectives: To compare lipid profiles in HIV-infected adults receiving atazanavir-based regimens.

Methods: We conducted a systematic review of randomized controlled trials (RCTs) comparing atazanavir or atazanavir/ritonavir with a comparator and evaluated lipids at 48 weeks. We searched MEDLINE, EMBASE, CENTRAL, LILACS, Current Controlled Trials, National Institutes of Health Clinical Trials Registry, trials at AIDSinfo and HIV conference proceedings to May 2009. Standardized mean difference (SMD) between study arms in change from baseline to week 48 in lipid parameters was determined weighted by study size and 95% confidence intervals (CI) were calculated.

Results: Nine eligible RCTs were identified (n=3346). SMDs (mmol/L) in four RCTs comparing atazanavir/ritonavir with a ritonavir-boosted protease inhibitor were: total cholesterol, -0.62 (95% CI -0.72, -0.51); low-density lipoprotein (LDL) cholesterol, -0.31 (95% CI -0.44, -0.17); high-density lipoprotein (HDL) cholesterol, -0.16 (95% CI -0.27, -0.06); non-HDL cholesterol, -0.58 (95% CI -0.69, -0.48); and triglycerides, -0.46 (95% CI -0.58, -0.34). Atazanavir compared with non-atazanavir (three RCTs) found lower total, LDL and non-HDL cholesterol, and triglycerides [SMD -0.87 mmol/L (95% CI -0.99, -0.76); -0.56 mmol/L (95% CI -0.67, -0.45); -0.88 mmol/L (95% CI -0.99, -0.76); and -0.56 mmol/L (95% CI -0.75, -0.36), respectively], but HDL cholesterol did not differ [-0.16 mmol/L (95% CI -0.49, 0.16)]. In the atazanavir/ritonavir versus atazanavir comparison (two RCTs), total [SMD 0.44 mmol/L (95% CI 0.23, 0.65)] and non-HDL cholesterol [SMD 0.44 mmol/L (95% CI 0.23, 0.65)] were higher, but HDL cholesterol, LDL cholesterol and triglycerides were not different.

Conclusions: At 48 weeks, plasma lipid concentrations were lower with atazanavir/ritonavir than with other ritonavir-boosted protease inhibitor regimens. Total and non-HDL cholesterol were higher with atazanavir/ritonavir than atazanavir alone.
Keyword Antiretroviral therapy
HDL
LDL
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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