Boosted- lopinavir versus boosted- atazanavir plus two nucleoside reverse transcriptase inhibitors in second- line antiretroviral therapy in HIV-1 infected patients in Abidjan (Ivory Coast)

Atazanavir is a protease inhibitor recently introduce in the therapeutic arsenal for second-line antiretroviral therapy in Ivory Coast. The objective of this study was to compare the efficacy and safety of a second-line treatment with 2 NRTIs + boosted lopinavir (LPV/r) versus 2 NRTIs + boosted atazanavir (ATV/r) in HIV-1 positive patients in Abidjan. Patients and Methods: Retrospective, comparative, single-center study, in 194 HIV-1 positive patients (143 with LPV/r, 51 with ATV/r), failed a first-line treatment, followed in Abidjan on 1 May 2009 to 30 June 2010. The analysis focused on clinical parameters and immuno-virological data. The principal judgement criterion was the proportion of patients with undetectable viral load in both groups after 12 months of HAART. Tolerance was found on the frequency of adverse events grade 3-4 during follow-up. Results: Clinically, improvement of the general condition and regression of opportunistic infections was similar in both groups. The average gain of CD4 after 12 months of follow-up was +357/mm3 in the LPV/r group versus +278 mm3 for ATV/r group (p = 0.012). The percentage of patients with undetectable viral load was similar in both groups (92% vs. 96% ; p = 0.535). The frequency of grade 3-4 adverse events was similar in both groups. Conclusion: HAART with LPV/r is at least as efficient as with ATV/r in second-line treatment, in terms of viral load reduction, with better recovery of CD4. LPV/r is an excellent second-line treatment in resource-limited countries. J Microbiol Infect Dis 2016;6(4): 149-155