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Atazanavir / Ritonavir Versus Lopinavir / Ritonavir-Based Combined Antiretroviral Therapy (Cart) for Hiv-1 Infection: A Systematic Review and Meta-Analysis Publisher Pubmed



Tigabu BM1, 2 ; Agide FD3 ; Mohraz M4 ; Nikfar S2
Authors
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Authors Affiliations
  1. 1. Haramaya University, School of Pharmacy, Ethiopia
  2. 2. Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, International Campus, Tehran, Iran
  3. 3. Department of Public Health officer, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
  4. 4. Department of infectious diseases, Tehran University of Medical Sciences, Tehran, Iran

Source: African Health Sciences Published:2020


Abstract

Background: This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of Atazanavir/ritonavir over lopinavir/ritonavir in human immunodeficiency virus-1 (HIV-1) infection. Methods: Clinical trials with a head-to-head comparison of atazanavir/ritonavir and lopinavir/ritonavir in HIV-1 were included. Electronic databases: PubMed/Medline CENTRAL, Embase, Scopus, and Web of Science were searched. Viral suppression below 50 copies/ml at the longest follow-up period was the primary outcome measure. Grade 2-4 treatment-related adverse drug events, lipid profile changes and grade 3-4 bilirubin elevations were used as secondary outcome measures. Results: A total of nine articles from seven trials with 1938 HIV-1 patients were included in the current study. Atazanavir/ritonavir has 13% lower overall risk of failure to suppress the virus level < 50 copies/ml than lopinavir/ritonavir in fixed effect model (pooled RR: 0.87; CI: 0.78, 0.96; P=0.006). The overall risk of hyperbilirubinemia is very high for atazanavir/ritonavir than lopinavir/ritonavir in the random effects model (pooled RR: 45.03; CI: 16.03, 126.47; P< 0.0001). Conclusion: Atazanavir/ritonavir has a better viral suppression at lower risk of lipid abnormality than lopinavir/ritonavir. The risk and development of hyperbilirubinemia from atazanavir-based regimens should be taken into consideration both at the time of prescribing and patient follow-up. © 2020 Tigabu BM et al. Licensee African Health Sciences.