Objective: To compare the efficiency and safety of atazanavir and nelfinavir in antiretroviral-naive patients.Design: Randomization to atazanavir 400 mg or 600 mg once daily; nelfinavir 1250 mg twice a day, plus lamivudine and stavudine.Methods: A blinded (to the atazanavir dose), 48-week trial in patients with HIV-1 RNA > 2000 copies/ml, CD4 cell count > 100 3 106cells/l. Primary end-point: change in HIV-1 RNA from baseline at 48 weeks. Secondary end-point: subjects with HIV-1 RNA, 400, and, 50 copies/ml, CD4 cell count changes, adverse events.Results: The 467 randomized subjects had comparable baseline characteristics across treatments. With atazanavir 400 mg, 600 mg and nelfinavir, respectively, mean changes in HIV-1 RNA (log10 copies/ml) from baseline to 48 weeks were -2.51, -2.58, -2.31; HIV-1 RNA , 400 copies/ml [intent-to-treat population (ITT), noncompletion failure (NC = F)], 64%, 67%, 53%; HIV-1 RNA , 50 copies/ml (ITT NC = F), 35%, 36%, 34%; mean CD4 cell count increased comparably at 48 weeks (234 3 106, 243 3 106, 211 3 106cells/l). Adverse events were similar across treatments with the exception of diarrhea (more frequent with nelfinavir) and jaundice (more frequent with atazanavir). Mean changes from baseline to 48 weeks were: fasting low density lipoprotein cholesterol, +5.2%, +7.1% and +23.2% (at 56 weeks) and fasting triglycerides (48 weeks), +7.2%, +7.6% and +49.5%, in the atazanavir 400 mg, 600 mg, and nelfinavir groups, respectively (P , 0.01, atazanavir versusnelfinavir).Conclusions: Atazanavir is a potent, safe, well tolerated, and effective once-daily protease inhibitor with low pill burden (two capsules/day). Lipid changes with atazanavir were significantly less than with nelfinavir, however, clinical significance of these finding in terms of decreased cardiovascular risk is unknown.

AIDS Care ปี 2546, December ปีที่: 17 ฉบับที่ 5 หน้า 2603-2614

disease, inhibitors, therapy, Antiretroviral, active, Atazanavir, Cardiovascular, Highly, Hyperlipidemia, Protease