Role of systemic inflammation scores for prediction of clinical outcomes in patients treated with atazanavir not boosted by ritonavir in the Italian MASTER cohort

• Published in: BMC infectious diseases 2017-03, Vol.17 (1), p.212-212, Article 212
• Main Authors: Postorino, Maria Concetta, Prosperi, Mattia, Focà, Emanuele, Quiros-Roldan, Eugenia, Di Filippo, Elisa, Maggiolo, Franco, Borghetti, Alberto, Ladisa, Nicoletta, Di Pietro, Massimo, Gori, Andrea, Sighinolfi, Laura, Pan, Angelo, Mazzini, Nicola, Torti, Carlo
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Angina pectoris; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral drugs; Atazanavir Sulfate - adverse effects; Atazanavir Sulfate - therapeutic use; Biomarkers; Cancer; Cardiovascular disease; Cardiovascular Diseases - epidemiology; CD4 Lymphocyte Count; Clinical outcomes; Diabetes; Disease Progression; Drug therapy; Female; Health risks; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human immunodeficiency virus; Humans; Incidence; Infectious diseases; Inflammation; Inflammation - complications; Inflammation - immunology; Inflammation - physiopathology; Italy - epidemiology; Kaplan-Meier Estimate; Kidney diseases; Kidney Diseases - epidemiology; Liver; Liver Diseases - epidemiology; Longitudinal Studies; Lymphocytes; Male; Middle Aged; Neutrophils; Nucleotides; Population; Regression analysis; Risk analysis; Risk Factors; Studies; Switches; Switching; Treatment Outcome; Triglycerides
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2322-z

Atazanavir (ATV) not boosted by ritonavir (uATV) has been frequently used in the past for switching combination antiretroviral therapy (cART). However, the clinical outcomes and predictors of such strategy are unknown. An observational study was carried out on the Italian MASTER, selecting HIV infected patients on cART switching to an uATV-containing regimen. Baseline was set as the last visit before uATV initiation. In the primary analysis, a composite clinical end-point was defined as the first occurring of any condition among: liver, cardiovascular, kidney, diabetes, non AIDS related cancer or death events. Incidence of AIDS events and incidence of composite clinical end-point were estimated. Kaplan-Meier and multivariable Cox regression analysis were used to assess predictors of the composite clinical end-point. 436 patients were observed. The majority of patients were males (61.5%) and Italians (85.3%), mean age was 42.7 years (IQR: 37.7-42), the most frequent route of transmission was heterosexual intercourse (47%), followed by injection drug use (25%) and homosexual contact (24%); the rate of HCV-Ab positivity was 16.3%. Patients were observed for a median time of 882 days (IQR: 252-1,769) under uATV. We recorded 93 clinical events (3 cardiovascular events, 20 kidney diseases, 33 liver diseases, 9 non AIDS related cancers, 21 diabetes, 7 AIDS events), and 19 deaths, accounting for an incidence of 3.7 (composite) events per 100 PYFU. At multivariable analysis, factors associated with the composite clinical end-point were intravenous drug use as risk factor for HIV acquisition vs. heterosexual intercourses [HR: 2.608, 95% CI 1.31-5.19, p = 0.0063], HIV RNA per Log copies/ml higher [HR: 1.612, 95% CI 1.278-2.034, p