Atazanavir / ritonavir versus Lopinavir / ritonavir-based combined antiretroviral therapy (cART) for HIV-1 infection: a systematic review and meta-analysis

  • Bereket Molla Tigabu
  • Feleke Doyore Agide
  • Minoo Mohraz
  • Shekoufeh Nikfar
Keywords: Atazanavir; Atazanavir/ritonavir; lopinavir/ritonavir; viral suppression.


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 pre- scribing and patient follow-up.

Keywords: Atazanavir; Atazanavir/ritonavir; lopinavir/ritonavir; viral suppression.


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eISSN: 1680-6905