J Korean Med Sci.  2008 Aug;23(4):737-739. 10.3346/jkms.2008.23.4.737.

Two Cases of Multidrug-Resistant Human Immunodeficiency Virus Infection Treated with Atazanavir and Lopinavir/Ritonavir Combination Therapy

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. seran@yuhs.ac
  • 2AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

The combination of atazanavir (ATV) and lopinavir/ritonavir (LPV/RTV) with nucleoside reverse transcriptase inhibitors (NRTI) has been used as a salvage regimen for human immunodeficiency virus (HIV)-positive patients. In this paper, we discuss two cases of HIV-positive patients who had long histories of virological failure following a heavy treatment of antiretroviral drugs, but then achieved virological suppression with double-boosted protease inhibitor (PI) regimens. In patients with multiple genotypic resistance to PIs and NRTIs, virological suppression can be achieved with a combination of ATV plus LPV/RTV with an NRTI backbone. The two cases in this report suggest that a combination of ATV plus LPV/RTV could be a useful salvage regimen for the subset of HIV-positive patients with limited treatment options.

Keyword

Double-Boosted Protease Inhibitor Therapy; Atazanavir; Lopinavir; Salvage Therapy; HIV Infections

MeSH Terms

Adult
Drug Resistance, Multiple, Viral
Drug Therapy, Combination
HIV Infections/*drug therapy
HIV Protease Inhibitors/*administration & dosage
Humans
Male
Oligopeptides/*administration & dosage
Pyridines/*administration & dosage
Pyrimidinones/*administration & dosage
Ritonavir/*administration & dosage

Cited by  2 articles

Antiretroviral Genotypic Resistance Mutations in HIV-1 Infected Korean Patients with Virologic Failure
Bum Sik Chin, Ju-Yeon Choi, Jin Young Choi, Gab Jung Kim, Mee-Kyung Kee, June Myung Kim, Sung Soon Kim
J Korean Med Sci. 2009;24(6):1031-1037.    doi: 10.3346/jkms.2009.24.6.1031.

Incidence of Atazanavir-associated Hyperbilirubinemia in Korean HIV Patients: 30 Months Follow-up Results in a Population with Low UDP-glucuronosyltransferase1A1*28 Allele Frequency
Pyoeng Gyun Choe, Wan Beom Park, Jin Su Song, Nak-Hyun Kim, Kyoung-Ho Song, Sang Won Park, Hong Bin Kim, Nam Joong Kim, Myoung-don Oh
J Korean Med Sci. 2010;25(10):1427-1430.    doi: 10.3346/jkms.2010.25.10.1427.


Reference

1. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998. 338:853–860.
2. Loutfy MR, Walmsley SL. Salvage antiretroviral therapy in HIV infection. Expert Opin Pharmacother. 2002. 3:81–90.
3. Gallant JE. Protease-inhibitor boosting in the treatment-experienced patient. AIDS Rev. 2004. 6:226–233.
4. Ribera E, Azuaje C, Lopez RM, Diaz M, Feijoo M, Pou L, Crespo M, Curran A, Ocana I, Pahissa A. Atazanavir and lopinavir/ritonavir: pharmacokinetics, safety and efficacy of a promising doubleboosted protease inhibitor regimen. AIDS. 2006. 20:1131–1139.
Article
5. Boffito M, Maitland D, Samarasinghe Y, Pozniak A. The pharmacokinetics of HIV protease inhibitor combinations. Curr Opin Infect Dis. 2005. 18:1–7.
Article
6. Gilliam BL, Chan-Tack KM, Qaqish RB, Rode RA, Fantry LE, Redfield RR. Successful treatment with atazanavir and lopinavir/ritonavir combination therapy in protease inhibitor-susceptible and protease inhibitor-resistant HIV-infected patients. AIDS Patient Care STDS. 2006. 20:745–759.
Article
7. Moyle GJ, Back D. Principles and practice of HIV-protease inhibitor pharmacoenahancement. HIV Med. 2001. 2:105–113.
8. Temesgen Z, Cainelli F, Poeschla EM, Vlahakis SA, Vento S. Approach to salvage antiretroviral therapy in heavily antiretroviral-experienced HIV-positive adults. Lancet Infect Dis. 2006. 6:496–507.
Article
9. De Luca A, Baldini F, Cingolani A, Di Giambenedetto S, Hoetelmans RM, Cauda R. Deep salvage with amprenavir and lopinavir/ritonavir: correlation of pharmacokinetics and drug resistance with pharmacodynamics. J Acquir Immune Defic Syndr. 2004. 35:359–366.
10. Taburet AM, Raguin G, Le Tiec C, Droz C, Barrail A, Vincent I, Morand-Joubert L, Chene G, Clavel F, Girard PM. Interactions between amprenavir and the lopinavir-ritonavir combination in heavily pretreated patients infected with human immunodeficiency virus. Clin Pharmacol Ther. 2004. 75:310–323.
11. Kashuba AD, Tierney C, Downey GF, Acosta EP, Vergis EN, Klingman K, Mellors JW, Eshleman SH, Scott TR, Collier AC. Combining fosamprenavir with lopinavir/ritonavir substantially reduces amprenavir and lopinavir exposure: ACTG protocol A5143 results. AIDS. 2005. 19:145–152.
Article
12. Khanlou H, Graham E, Brill M, Farthing C. Drug interaction between amprenavir and lopinavir/ritonavir in salvage therapy. AIDS. 2002. 16:797–798.
Article
13. Mauss S, Scholten S, Wolf E, Berger F, Schmutz G, Jaeger H, Kurowski M, Rockstroh JK. A prospective, controlled study assessing the effect of lopinavir on amprenavir concentrations boosted by ritonavir. HIV Med. 2004. 5:15–17.
Article
14. Ribera E, Lopez RM, Diaz M, Pou L, Ruiz L, Falco V, Crespo M, Azuaje C, Ruiz I, Ocana I, Clotet B, Pahissa A. Steady-state pharmacokinetics of a double-boosting regimen of saquinavir soft gel plus lopinavir plus minidose ritonavir in human immunodeficiency virusinfected adults. Antimicrob Agents Chemother. 2004. 48:4256–4262.
Article
15. Stephan C, Hentig N, Kourbeti I, Dauer B, Mosch M, Lutz T, Klauke S, Harder S, Kurowski M, Staszewski S. Saquinavir drug exposure is not impaired by the boosted double protease inhibitor combination of lopinavir/ritonavir. AIDS. 2004. 18:503–508.
Article
16. Boffito M, Kurowski M, Kruse G, Hill A, Benzie AA, Nelson MR, Moyle GJ, Gazzard BG, Pozniak AL. Atazanavir enhances saquinavir hard-gel concentrations in a ritonavir-boosted once-daily regimen. AIDS. 2004. 18:1291–1297.
Article
17. Staszewski S, Babacan E, Stephan C, Haberl A, Carlebach A, Gute P, Klauke S, Hermschulte Y, Stuermer M, Dauer B. Frankfurt HIV Cohort. The LOPSAQ study: 48 week analysis of a boosted double protease inhibitor regimen containing lopinavir/ritonavir plus saquinavir without additional antiretroviral therapy. J Antimicrob Chemother. 2006. 58:1024–1030.
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr