Atazanavir vs Lopinavir-Ritonavir in Treatment-Naive CASTLE Study
Explore the comparative efficacy of Atazanavir-Ritonavir vs Lopinavir-Ritonavir in treatment-naive HIV patients based on the CASTLE study. The study design, treatment arms, and virologic responses at Week 48 are discussed along with changes in fasting lipids from baseline. Check out the results for insights into the management of HIV infection.
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Atazanavir + ritonavir vs. Lopinavir-ritonavir CASTLE Study
Atazanavir + Ritonavir vs. Lopinavir-ritonavir in Treatment-Nave CASTLE: Study Design Study Design: CASTLE Background: Randomized, open label trial to evaluate the comparative efficacy of once-daily atazanavir + ritonavir versus twice-daily lopinavir- ritonavir, each with fixed dose tenofovir DF- emtricitabine, in treatment-na ve adults with HIV infection Atazanavir + Ritonavir + Tenofovir DF-Emtricitabine (n = 440) Inclusion Criteria (n = 883) - Age 18 - Antiretroviral treatment-na ve - HIV RNA >5000 copies/mL - No CD4 count restrictions Lopinavir-ritonavir + Tenofovir DF-Emtricitabine (n = 443) Treatment Arms - Atazanavir 300 mg QD+ Ritonavir 100 mg QD + Tenofovir DF-emtricitabine QD - Lopinavir-ritonavir 400-100mg BID + Tenofovir DF-emtricitabine QD Source: Molina JM, et al. Lancet. 2008;372:646-55.
Atazanavir + Ritonavir vs. Lopinavir-ritonavir in Treatment-Nave CASTLE: Results Week 48: Virologic Response, by Baseline HIV RNA ( ITT: CVR, NC= F*) Atazanavir + Ritonavir + TDF-FTC Lopinavir-Ritonavir + TDF-FTC 100 HIV RNA <50 copies/mL (%) 82 81 78 76 80 74 72 60 40 20 0 All <100,000 copies/mL 100,000 copies/mL Baseline HIV RNA *ITT= intent to treat; CVR = confirmed virologic response; NC = non completer = failure Source: Molina JM, et al. Lancet. 2008;372:646-55.
Atazanavir + Ritonavir vs. Lopinavir-ritonavir in Treatment-Nave CASTLE: Results Week 48: Virologic Response, by Baseline CD4 Cell Count Atazanavir + Ritonavir + TDF-FTC Lopinavir-Ritonavir + TDF-FTC 100 HIV RNA <50 copies/mL (%) 80 80 78 78 76 75 80 69 63 60 40 20 0 >200 100-200 50-100 <50 Baseline CD4 Count (cells/mm3) *ITT= intent to treat; CVR = confirmed virologic response; NC = non completer = failure Source: Molina JM, et al. Lancet. 2008;372:646-55.
Atazanavir + Ritonavir vs. Lopinavir-ritonavir in Treatment-Nave CASTLE: Results Week 48: Change in Fasting Lipids from Baseline Atazanavir + Ritonavir + TDF-FTC Lopinavir-Ritonavir + TDF-FTC 60 Change from baseline at week 48 51* *P < 0.0001 50 40 32 (%) 27 30 24* 21* 20 15 13 12 12 7 10 0 Total LDL HDL Non-HDL Cholesterol Fasting Triglycerides Cholesterol Cholesterol Cholesterol Source: Molina JM, et al. Lancet. 2008;372:646-55.
Atazanavir + Ritonavir vs. Lopinavir-ritonavir in Treatment-Nave CASTLE: Conclusions Interpretation: In treatment-naive patients, atazanavir/ritonavir once- daily demonstrated similar antiviral efficacy to lopinavir/ritonavir twice- daily, with less gastrointestinal toxicity but with a higher rate of hyperbilirubinaemia. Source: Molina JM, et al. Lancet. 2008;372:646-55.
Acknowledgment The National HIV Curriculum is an AIDS Education and Training Center (AETC) Program resource funded by the United States Health Resources and Services Administration. The project is led by the University of Washington and the AETC National Coordinating Resource Center. The content in this slide set does not represent the official views of the U.S. Department of Health and Human Services, Health Resources & Services Administration.
