462. HIV Virologic Outcomes Associated with Ritonavir-boosted Atazanavir and Concomitant Acid Suppressive Therapy
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Atazanavir is one of the most widely used protease inhibitors. Multiple pharmacokinetic studies suggest that the serum concentrations of atazanavir are decreased with the concomitant usage of acid suppressive therapy. However there are limited data evaluating the clinical or virologic outcomes in HIV-positive patients.  The current analysis investigates the proportion of virologic failure among HIV-positive patients on ritonavir-boosted atazanavir with and without concomitant acid suppressive therapy.

Methods: 

Retrospective data from medical charts of 335 HIV-positive patients receiving care at the Hillsborough County Health Department from July 1, 2003 to June 30, 2010 were analyzed. The primary endpoint was virologic failure,defined as HIV RNA PCR > 400 cells/mL on two consecutive viral load measurements, in patients taking ritonavir-boosted atazanavir with and without acid suppressants for at least nine months.  Acid suppressive therapy included both proton pump inhibitors and H2 blockers.

Results: 

335 patients on ritonavir-boosted atazanavir were separated into two groups: those receiving acid suppressive therapy (n=64) and those not receiving acid suppressive therapy (n=271).  The mean ages were 46.1 and 44.2 years, respectively.  There were a higher percentage of women in the acid-suppressive group, 46.9% versus 28.4%.  The mean baseline CD4 counts were similar at 378.3 cells/µL in the acid suppressive group and 342.4 cells/µL in the non-acid suppressive group.  The most common concomitant nucleoside reverse transcriptase inhibitors used in the two arms were tenofovir (82.8% and 84.5%) and emtricitabine (67.2% and 73.1%).  The percentage of virologic failure was found to be 12.5% and 16.6%, respectively (P=0.4653 by Fisher exact test).

Conclusion: 

We found no difference in virologic failure among HIV-positive patients receiving ritonavir-boosted atazanavir with concomitant acid suppressants and those not receiving acid suppressants.  When selecting an anti-retroviral regimen, the patient’s need for acid suppressants should not discourage providers from selecting atazanavir as part of the initial regimen.


Subject Category: H. HIV/AIDS and other retroviruses

Ulyee Choe, DO1, Georgina Nasr, MD2, Madhvi Shah3, Charurut Somboonwit, MD4, Jose Montero, MD3, Ren Chen, MD, MPH3 and Lynette Menezes, PhD3, (1)Infectious Disease, University of South Florida, Tampa, FL, (2)Infectious Diseases, University of South Florida, Tampa, FL, (3)University of South Florida, Tampa, FL, (4)Infectious Disease and International Medicine, University of South Florida College of Medicine, Tampa, FL

Disclosures:

U. Choe, None

G. Nasr, None

M. Shah, None

C. Somboonwit, Merck: Investigator, Grant recipient and Research grant

J. Montero, None

R. Chen, None

L. Menezes, None

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