Outcomes in HIV Patients on Two Different Protease Inhibitors on Second-Line Antiretroviral Therapy: An Observational Study

Introduction: There were 38 million people living with HIV in the world in 2019, out of which 5.8 million were living within the Asia-Pacific region. Globally, 67% (25.4 million) and within the Asia-Pacific region, 60% (3.5 million) of the individuals living with HIV were accessing anti-retroviral therapy (ART) respectively. Approximately 4% of the patients on ART are on second-line therapy. The aim of this research was to analyze the difference in efficacy and tolerance of boosted lopinavir and boosted atazanavir as part of second-line ART regimens and factors associated with the difference. Materials and Methods: The observational study was conducted at a referral ART clinic of a tertiary care hospital in North India. This was an ambispective study on patients under evaluation for first-line treatment failure. One hundred and fifteen and sixty patients were recruited to lopinavir and atazanavir study groups, respectively. Efficacy was assessed by adequate suppression of plasma viral loads 12 months after starting therapy with protease inhibitors. Results: Both the regimens are highly effective in reducing viral loads. Regarding adverse drug reactions (ADRs), hyperlipidemia and abnormal liver function test (transaminitis) were the most common ADRs in the lopinavir study group, whereas nausea, fever, and indirect hyperbilirubinemia were the most common ADRs in the atazanavir study group. Conclusions: Lopinavir and atazanavir are both highly effective in reducing viral loads and produced comparable CD4 levels post 1-year follow-up.