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Atazanavir associated with higher triglycerides, fat levels vs. darunavir
Although there was no difference in efficacy between atazanavir/ritonavir and darunavir/ritonavir, the atazanavir regimen was linked to higher triglycerides and total and subcutaneous abdominal adipose tissue among patients with HIV, new data suggest.
Researchers also found that changes in BMI, total body fat and subcutaneous abdominal adipose tissue (SAT) were significantly related to insulin resistance in the atazanavir (Reyataz, Bristol-Myers Squibb) arm.
“In this context, it was surprising that limb fat and SAT, which reflect the same subcutaneous fat compartment, consistently increased more in the atazanavir arm … while visceral abdominal adipose tissue increased similarly in both arms,” the researchers wrote in Clinical Infectious Diseases.
“Subcutaneous fat in the limbs has been traditionally associated with beneficial metabolic effects while visceral abdominal adipose tissue has been considered a major culprit in development of insulin resistance.”
Researchers from the University of Barcelona compared atazanavir boosted with ritonavir (Norvir, AbbVie) and darunavir (Prezista, Janssen) boosted with ritonavir in the ATADAR study. ART-naive adults with HIV were randomly assigned to one of the protease inhibitors in combination with tenofovir/emtricitabine (Truvada, Gilead Sciences). They evaluated efficacy and adverse events, as well as laboratory and body composition changes at 96 weeks.
They found no difference in efficacy between the two regimens in terms of treatment or virological failure. Seven patients in the atazanavir/ritonavir arm and five patients in the darunavir/ritonavir arm discontinued therapy due to adverse effects. The total and HDL cholesterol levels increased significantly in both arms. Increases in triglycerides were greater in the atazanavir/ritonavir arm at week 96, an estimated difference of 21.5 mg/dL.
At 96 weeks, body fat, limb fat and SAT increased more in the atazanavir arm vs. the darunavir arm. The estimated difference in body fat was 2,862.2 g (P=.009). The estimated limb fat difference was 1,403.3 g (P=.0071), and the estimated SAT difference was 28.4 cm2 (P=.0362). In the atazanavir arm, changes in body fat were linked to insulin resistance.
“Further studies will be needed to confirm our observations and to determine their clinical relevance,” the researchers wrote.
Disclosure: See study for a full list of relevant financial disclosures.