Switch to atazanavir associated with cholesterol and triglyceride reductions

Atazanavir is an investigational protease inhibitor being developed by Bristol-Myers Squibb company. It is currently in phase III clinical trials.

Data presented today at the 14th International AIDS conference in Barcelona demonstrated that a switch to atazanavir from the licensed protease inhibitor nelfinavir was associated with significant reductions in blood levels of total cholesterol, low density lipoprotein (LDL) or “bad” cholesterol and triglycerides.

The study (AI424-044) included 346 people (217 men, 129 women) who had previously completed on average 76 weeks of treatment in a prior atazanavir study which had compared 400mg and 600mg atazanavir once daily to nelfinavir alongside d4T and 3TC.

In total 63 patients were switched from nelfinavir to 400mg atazanavir with d4T and 3TC. At 12 weeks, the switch was associated with significant reductions in total cholesterol (16%), LDL cholesterol (21%) and triglycerides (28%) and a significant increase in high density lipoprotein (HDL) “good” cholesterol (5%). The switch was associated with a decrease in the proportion of patients with undesirable levels of triglycerides (>240 milligrams per deciliter (mg/dl) of blood) from 32% to 10% and LDL cholesterol (>130mg/dl) from 55% to 22%.

Minimal changes in cholesterol and triglyceride levels were seen in patients who remained on the 400mg or 600mg dose of atazanavir.

Presenting the data Dr Rob Murphy, Director of HIV clinical research at Northwestern University said these data “demonstrate a potentially significant reduction in cardiovascular risk factors, when switching from nelfinavir to atazanavir".

These encouraging results follows data presented yesterday by Dr Guiseppe Barbero and reported on aidsmap implicating the metabolic disorders associated with use of protease inhibitors in the development of angina and heart attack.