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Boosted vs. Unboosted Reyataz

Sep 27, 2009

There was a study (ARIES) released at IAS 2009 which indicated that unboosted Reyataz performed as well as boosted Reyataz with Epzicom. Has this caused you to change your prescribing practices regarding Reyataz in your clinic? Thanks.

Response from Dr. Young

Hello and thanks for your post.

As an author in the ARIES trial, your question to me is a good one to ask. This study initiated all patients with abacavir/3TC (Epzicom, Kivexa) and ritonavir (Norvir)-boosted atazanavir (Reyataz). After viral loads were suppressed, patients were randomly assigned to continue their ritonavir, or discontinue (with dose adjustment of atazanavir). Overall, the results showed that the two groups did very similarly, with only rare viral failure, and no obvious differences in the viral resistance patterns in these few patients.

First, I think that many persons taking boosted PIs do extremely well, despite the sometimes obvious issues with ritonavir (Norvir). Nevertheless, there's considerable interest in evaluating if the benefits of boosted PIs require the continuous use of the ritonavir, or if an early phase induction with ritonavir (without long-term exposure) could yield similar results (with less drug exposure and costs).

A couple of points deserve comment. First, this study does not evaluate starting with Epzicom with unboosted Reyataz, rather starts with the boosted PI, then switches unboosted later. Second, this strategy should NOT be utilized with tenofovir/FTC (Truvada), since the tenofovir part of Truvada significantly lowers Reyataz levels; requiring Norvir boosting.

The study certainly has offered an alternative for those currently taking Epzicom with boosted Reyataz-- namely, that one could pretty safely discontinue the Norvir and continue on the simple once-daily regimen of Epzicom/Reyataz. I've considered this option in patients who are currently challenged by the cost, lipids or side effects of the Norvir (while on this regimen). Previous data from the DAD study raised concerns about heart disease and abacavir. Given the recent data from the IAS meeting which, in my opinion, has very much lessened my concern about heart disease risks and abacavir, I think that the Epzicom/Reyataz regimen deserves thought.

Thanks for reading. BY

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