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Comparison of Body Composition Changes Between Atazanavir/Ritonavir and Lopinavir/Ritonavir Each in Combination with Tenofovir/Emtricitabine in Antiretroviral-Naïve Patients with HIV-1 Infection

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Abstract

Background and Objective

Antiretroviral drug regimen choice may influence changes in body composition. The objective of this study was to compare changes in body composition between ritonavir-boosted atazanavir (ATV/r) and ritonavir-boosted lopinavir (LPV/r) over 96 weeks using data from a substudy of CASTLE, which compared once-daily ATV/r with twice-daily LPV/r, both in combination with tenofovir disoproxil fumarate/emtricitabine in treatment-naïve patients with HIV-1 infection.

Methods

We examined 224 patients (125 on ATV/r; 99 on LPV/r) at baseline, 48 and 96 weeks using dual-energy X-ray absorptiometry and computerised tomography.

Results

In the lowest baseline body mass index (BMI) group, there were significantly greater gains at week 96 for ATV/r than for LPV/r in subcutaneous adipose tissue and in visceral adipose tissue (VAT). By week 96, patients with lowest baseline CD4 cell counts on ATV/r had 28 % increases in VAT versus 14 % reductions for patients receiving LPV/r. Those with the lowest baseline BMI on ATV/r had 19 % increases in VAT versus reductions of 5 % for patients on LPV/r. In the highest baseline BMI group, the mean increase in triglycerides was 6 and 70 % in the ATV/r and LPV/r arms, respectively. Compared with baseline, an increase in proportion of patients with high waist circumference (WC)/high triglycerides at 96 weeks was noted in both treatment arms, but this increase was numerically greater with LVP/r (18 %) than with ATV/r (11 %).

Conclusion

Truncal fat gains on ATV/r primarily led to increases in WC, which may reflect return to health, while on LPV/r increases in WC and triglycerides occurred. Changes in body composition with antiretroviral therapy are influenced by treatment choice and baseline characteristics.

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Acknowledgments

The study group would like to acknowledge the patients and their families for their participation and commitment during the study, the co-investigators who participated in this substudy, and the Bristol-Myers Squibb (BMS) study team. This BMS-supported study is also known as Study AI424138 and is registered with ClinicalTrials.gov, number NCT00272779. Professional medical writing and editorial assistance was provided by Emily Cullinan and Carolyn Carroll, employees of BMS, and Julian Martins, an employee of inScience communications, Springer Healthcare, which was funded by BMS.

Funding Source

Bristol-Myers Squibb.

Disclosure Statement

GM has received research grants or been a speaker/advisor for BMS, Gilead, Merck, Viiv Healthcare, Pfizer, GSK and Theratechnologies, and has received a grant from Abbott Laboratories. HH, AF, MD and DM are employees and shareholders of BMS.

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Authors and Affiliations

  1. St. Stephens AIDS Research, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK

    Graeme J. Moyle

  2. Bristol-Myers Squibb, Plainsboro, NJ, USA

    Hélène Hardy & Awny Farajallah

  3. Bristol-Myers Squibb, Wallingford, CT, USA

    Michelle DeGrosky & Donnie McGrath

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  1. Graeme J. Moyle
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Correspondence to Graeme J. Moyle.

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Moyle, G.J., Hardy, H., Farajallah, A. et al. Comparison of Body Composition Changes Between Atazanavir/Ritonavir and Lopinavir/Ritonavir Each in Combination with Tenofovir/Emtricitabine in Antiretroviral-Naïve Patients with HIV-1 Infection. Clin Drug Investig 34, 287–296 (2014). https://doi.org/10.1007/s40261-014-0175-4

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