{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:36:58Z","timestamp":1790005018434,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,12,9]],"date-time":"2013-12-09T00:00:00Z","timestamp":1386547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Treatment simplification involving induction with a ritonavir (<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content>)\u2010boosted protease inhibitor (<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>) replaced by a nonboosted <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> (i.e. atazanavir) has been shown to be a viable option for long\u2010term antiretroviral therapy. To evaluate the clinical evidence for this approach, we conducted a systematic review and meta\u2010analysis of randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCTs<\/jats:styled-content>) evaluating efficacy and safety in patients with established virological suppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Several databases were searched without limits on time or language. Searches of conferences were also conducted. <jats:styled-content style=\"fixed-case\">RCTs<\/jats:styled-content> were included if they compared a <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content> regimen to unboosted atazanavir, after induction with <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content>. The meta\u2010analysis was conducted using a random effects model for the proportion achieving virological suppression (i.e. <jats:styled-content style=\"fixed-case\">HIV RNA<\/jats:styled-content>\u2009&lt;\u200950 and &lt;400 <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> copies\/mL), <jats:styled-content style=\"fixed-case\">CD4<\/jats:styled-content> cell counts, lipid levels and liver function tests. Dichotomous outcomes were reported as risk ratios (<jats:styled-content style=\"fixed-case\">RRs<\/jats:styled-content>) and continuous outcomes as mean differences (<jats:styled-content style=\"fixed-case\">MDs<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five studies (<jats:italic>n<\/jats:italic>\u2009=\u20091249) met the inclusion criteria. The meta\u2010analysis demonstrated no statistically significant difference in efficacy (i.e. <jats:styled-content style=\"fixed-case\">HIV RNA<\/jats:styled-content>\u2009&lt;\u200950\u2009copies\/mL) between <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content> and unboosted atazanavir [<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u2009=\u20091.04; 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 0.99 to 1.10], with no heterogeneity. Findings were similar in a subanalysis of studies where atazanavir\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content> was the only <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content> used during induction. Additional efficacy results support these findings. A significant reduction in total cholesterol (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.00001), triglycerides (<jats:italic>P<\/jats:italic>\u2009=\u20090.0002), low\u2010density lipoprotein (<jats:styled-content style=\"fixed-case\">LDL<\/jats:styled-content>) cholesterol (<jats:italic>P<\/jats:italic>\u2009=\u20090.009) and hyperbilirubinaemia (<jats:italic>P<\/jats:italic>\u2009=\u20090.02) was observed with unboosted atazanavir <jats:italic>vs.<\/jats:italic>\u2005<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The meta\u2010analysis demonstrated that switching patients with virological suppression from an <jats:styled-content style=\"fixed-case\">RTV<\/jats:styled-content>\u2010boosted <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> to unboosted atazanavir leads to improvements in safety (i.e. blood parameter abnormalities) without sacrificing virological efficacy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12118","type":"journal-article","created":{"date-parts":[[2013,12,9]],"date-time":"2013-12-09T09:25:40Z","timestamp":1386581140000},"page":"301-310","source":"Crossref","is-referenced-by-count":18,"title":["A meta\u2010analysis of the efficacy and safety of unboosted atazanavir compared with ritonavir\u2010boosted protease inhibitor maintenance therapy in HIV\u2010infected adults with established virological suppression after induction"],"prefix":"10.1111","volume":"15","author":[{"given":"J","family":"Baril","sequence":"first","affiliation":[{"name":"Hospital of the University of Montreal  Montr\u00e9al QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Conway","sequence":"additional","affiliation":[{"name":"The University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Gigu\u00e8re","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Ferko","sequence":"additional","affiliation":[{"name":"Cornerstone Research Group  Burlington ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Hollmann","sequence":"additional","affiliation":[{"name":"Cornerstone Research Group  Burlington ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JB","family":"Angel","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7961"},{"key":"e_1_2_8_3_1","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in HIV\u20101\u2010infected adults and adolescents. 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