NEW YORK (Reuters Health) - In patients with AIDS previously treated with atazanavir or nelfinavir, extended use of atazanavir with stavudine and lamivudine effectively suppresses HIV levels without inducing clinically relevant changes in lipid levels, according to new findings from an ongoing, open-label, rollover/switch study published in the June 1st Journal of Acquired Immune Deficiency Syndrome.

"Patients can now expect virologic control and a favorable lipid profile by taking an atazanavir-containing HAART regimen," Dr. Michael Giordano from the Pharmaceutical Research Institute at Bristol-Myers Squibb (BMS) Company in Wallingford, Connecticut noted in comments to Reuters Health.

The once-daily dosing of atazanavir (Reyataz) coupled with its favorable effects on lipids make it an attractive alternative to other protease inhibitors (PIs) for long-term use, Dr. Giordano and colleagues note in the paper (see Reuters Health report Feb. 28, 2003).

In the paper they report efficacy and safety data of a median cumulative 108 weeks of extended atazanavir therapy in treatment-na�ve as well as treated-experienced patients.

A total of 346 HIV-infected patients completing at least 48 weeks of atazanavir (400 or 600 mg once daily) or nelfinavir (1250 mg twice daily) plus lamivudine (150 mg twice daily) and weight-dependent doses of stavudine twice daily and having a plasma HIV RNA viral load less than 10,000 copies/mL were eligible to continue on atazanavir or to switch from nelfinavir to atazanavir.

"Extended use of atazanavir in treatment-na�ve patients resulted in sustained virologic suppression over a median treatment time of approximately 108 weeks and in continued increases in CD4+ cell count," the investigators report.

"Patients switched to atazanavir from nelfinavir showed increased viral suppression and CD4+ cell counts to levels comparable to the original atazanavir treatment groups...suggesting that virologically suppressed nelfinavir-treated patients can switch to atazanavir without loss of antiviral efficacy," they add.

Confirming past studies, atazanavir-treated patients showed "minimal changes" in lipid levels compared with baseline. Moreover, nelfinavir-induced lipid elevations were reduced to near pretreatment values within 12 weeks of switching to atazanavir.

Atazanavir "may preclude the need to introduce the use of lipid-lowering agents to control PI-induced dyslipidemia in a significant proportion of patients," the investigators write.

J Acquir Immune Defic Syndr 2004;36:684-692.