ART Simplification Does Not Affect Systemic Inflammation in Virologically Suppressed HIV

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Simplification to atazanavir/ritonavir plus lamivudine as a maintenance therapy has the same effect on markers of systemic inflammation biomarkers as triple therapy.

For virologically suppressed patients infected with HIV, switching to a dual antiretroviral maintenance therapy of atazanavir/ritonavir plus lamivudine does not affect plasma markers of systemic inflammation, according to results published in the Journal of Antimicrobial Chemotherapy.

The study was a substudy of the randomized ATLAS-M trial, an open-label noninferiority trial that randomly assigned patients to switch to 300/100 mg atazanavir/ritonavir plus 300 mg lamivudine once daily or remain taking prior regimen of 2 nucleoside reverse transcriptase inhibitors plus atazanavir/ritonavir.

The researchers compared the effect of simplification to a dual therapy with atazanavir/ritonavir plus lamivudine vs maintaining atazanavir/ritonavir plus 2 nucleoside reverse transcriptase inhibitors on markers of systemic inflammation in virologically suppressed participants after 1 year (n=139).

Plasma levels of interleukin 6, C-reactive protein, soluble CD14 (sCD14), and D-dimer were quantified by ELISA at baseline and at 48 weeks.

Of the 139 participants, 69 were in the triple-therapy group and 70 were in the dual-therapy group. At baseline, the biomarker levels were comparable between the groups.

The results did not indicate any significant differences in changes from baseline to week 48 between arms (dual therapy vs triple therapy): interleukin 6, −0.030 vs −0.016 log10pg/L; C-reactive protein, 0.022 vs 0.027 log10pg/mL; sCD14, −0.016 vs 0.019 log10pg/mL; and D-dimer, −0.031 vs 0.004 log10pg/mL.

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A history of cancer was associated with higher baseline levels of interleukin 6 (P =.002) and C-reactive protein (P =.049). There was no relationship between baseline biomarker level and persistent residual viremia, HIV-1 DNA load, plasma lipids, and other potential explanatory variables.

“Simplification to atazanavir/ritonavir plus lamivudine as a maintenance therapy has the same impact on systemic inflammation biomarkers as continued atazanavir/ritonavir with two [nucleoside reverse transcriptase inhibitors in virologically controlled patients],” the study authors concluded.


Belmonti S, Lombardi F, Quiros-Roldan E, et al. Systemic inflammation markers after simplification to atazanavir/ritonavir plus lamivudine in virologically suppressed HIV-1-infected patients: ATLAS-M substudy [published online April 17, 2018]. J Antimicrob Chemother. doi:10.1093/jac/dky125