Abstract
Atazanavir is a protease inhibitor indicated, in combination with other antiretrovirals, as an initial treatment of HIV infection or in previously treated patients. Antiretroviral treatment based on atazanavir has been associated with a low incidence of hepatotoxicity, both in Clinical Trials as well as in cohort studies. However, the finding of hyperbilirubinaemia has been common in these studies, although it usually does not involve withdrawing the treatment. In patients co-infected with hepatitis B or C, the level of virological response to does not appear to be affected and the incidence of adverse effects, except the higher incidence of hepatotoxicity, is no higher than in non-coinfected subjects. The incidence of severe hepatotoxicity (grade 3-4) in patients coinfected by HIV and HVC who receive drug combinations that contain atazanavir is 6%. Atazanavir has a favourable tolerance and safety profile in patients coinfected with hepatitis virus even in the presence of significant fibrosis. The lower association of atazanavir with the development of insulin resistance, a fact that has been associated with increasing the progression to hepatic fibrosis and lower treatment response rates, could be an added benefit of the use atazanavir in coinfected patients and could serve as an additional argument for its use in these patients.
MeSH terms
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Anti-HIV Agents / administration & dosage
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Anti-HIV Agents / adverse effects
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Anti-HIV Agents / therapeutic use
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Antiretroviral Therapy, Highly Active
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Atazanavir Sulfate
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Chemical and Drug Induced Liver Injury / etiology
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Clinical Trials as Topic / statistics & numerical data
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Cohort Studies
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Disease Progression
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Drug Therapy, Combination
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HIV Infections / complications
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HIV Infections / drug therapy*
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HIV Protease Inhibitors / administration & dosage
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HIV Protease Inhibitors / adverse effects*
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HIV Protease Inhibitors / pharmacology
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HIV Protease Inhibitors / therapeutic use
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Hepatitis B, Chronic / complications*
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Hepatitis B, Chronic / metabolism
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Hepatitis C, Chronic / complications*
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Hepatitis C, Chronic / metabolism
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Hepatitis D, Chronic / complications
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Hepatitis D, Chronic / metabolism
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Humans
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Hyperbilirubinemia / chemically induced*
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Insulin Resistance
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Liver / drug effects
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Liver / metabolism
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Liver Cirrhosis / complications
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Liver Cirrhosis / metabolism
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Multicenter Studies as Topic / statistics & numerical data
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Oligopeptides / administration & dosage
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Oligopeptides / adverse effects*
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Oligopeptides / pharmacology
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Oligopeptides / therapeutic use
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Pyridines / administration & dosage
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Pyridines / adverse effects*
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Pyridines / pharmacology
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Pyridines / therapeutic use
Substances
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Anti-HIV Agents
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HIV Protease Inhibitors
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Oligopeptides
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Pyridines
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Atazanavir Sulfate