13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

EFFECTS OF ATAZANAVIR OR SAQUINAVIR QD WITH RITONAVIR 100 MG AND TENOFOVIR/EMTRICITABINE AS INITIAL THERAPY FOR HIV-1 INFECTION ON PERIPHERAL GLUCOSE DISPOSAL: A RANDOMIZED OPEN LABEL STUDY

HIV Med 2007; 8(Suppl. 1):8 (abstract no. O29)

Akil Jackson¹, Nimesh Patel², Kasha Singh¹, Gary Lo¹, Graeme Moyle¹ and Brian Gazzard^1
1Chelsea and Westminster Foundation NHS Trust, London, UK, ²Imperial College Medical School, London, UK

BACKGROUND: Some protease inhibitors (PI) are associated with insulin resistance. Healthy volunteer (HV) studies of unboosted 400 mg atazanavir (ATV) for 5 days did not alter glucose disposal rates during hyperinsulinaemic euglycaemic clamp (EugCl). Changes observed in similar studies have illustrated reductions in glucose disposal (GD) of 10% with atazanavir/ritonavir (ATV/r) 300/100 mg, 17% with 4 weeks of indinavir, and a 23% lower insulin sensitivity index with lopinavir/ritonavir. There are no data on the effect of either atazanavir or saquinavir on GD when given as part of initial regimens to HIV+ subjects.

METHODS: A single-centre, randomized, open-label trial comparing the effect of saquinavir/ritonavir (SQV/r) 2000/100 mg with ATV/r 300/100 mg (both qd), with Truvada on GD using EugCl at baseline and at week 4.

RESULTS: Twenty-eight HIV+ males, naïve to therapy and without metabolic disorders were randomized; 14 to SQV/r and 14 to ATV/r. GD was determined for 120–180 min of the EugCl. The median percentage change in GD for treatment with SQV/r was an 8.7% decrease (range from -33.6 to +32.0%) compared with a decrease of 3.0% (range from -26.4 to +103.7%) with ATV/r. Median changes in lipid parameters over 4 weeks for SQV/r and ATV/r were: total cholesterol (+0.45 versus +0.15 mmol/l), fasting triglycerides (+0.50 versus +0.24 mmol/l), HDL cholesterol (+0.01 versus +0.07) and LDL-cholesterol (+0.06 versus +0.09 mmol/l) respectively.

CONCLUSION: Variable changes in glucose disposal are seen with both SQV/r and ATV/r at 4 weeks after initiation of antiretroviral therapy, with a modest median reduction in glucose disposal with SQV/r. Changes observed in the HIV treatment setting may differ from those observed in healthy volunteers. Lipid changes were modest with more favourable changes in triglycerides and HDL observed with ATV/r.

2007-03-29
O29

Copyright © 2007 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD