OASIS

Presentation Abstract

Session Number:

103

Monday, Sep 10, 2012, 11:15 AM - 1:15 PM

Presentation Title:

H-888 - High Incidence of Renal Stones in HIV-infected Patients on Ritonavir-boosted Atazanavir- than in Those on Other Protease Inhibitors-containing Antiretroviral Therapy

Location:

Halls A-C

Presentation Number:

H-888

Pres. Time:

Monday, Sep 10, 2012, 11:15 AM - 1:15 PM

Category:

Keywords:

HIV infections/complications; atazanavir; protease inhibitor

Author(s):

Y. Hamada, MD - fellow¹, T. Nishijima, MD - fellow ¹, K. Watanabe, MD - staff doctor ¹, H. Komatsu, MD - director ², K. Tsukada, MD - director ¹, H. Gatanaga, MD - director ¹, Y. Kikuchi, MD - director ¹, S. Oka, MD - director general ¹;
¹AIDS clinical Cetr., Natl. Cetr. for Global Hlth. and Med., Tokyo, Japan, ²Saku Central Hosp., Nagano, Japan.

Financial Disclosures:

Y. Hamada, None..
T. Nishijima, None..
K. Watanabe, None..
H. Komatsu, None..
K. Tsukada, None..
H. Gatanaga, None..
Y. Kikuchi, None.
S. Oka,
MSD KK Role(s): Research Contractor.
Roche Daiagnostics KK Role(s): Research Contractor.
AbbottJapan Co Role(s): Research Contractor.
Janssen Pharmaceutical Co Role(s): Research Contractor.
Pfizer Co Role(s): Research Contractor.

Abstract:

Background: Little information is available on the incidence of renal stones (RS) with ritonavir-boosted atazanavir (ATV/r) use. Methods: The incidence of RS was compared between patients who commenced ATV/r-containing antiretroviral therapy (ART) and those on other protease inhibitors (other PIs). The effects of ATV/r were estimated by univariate and multivariate Cox hazards models. Other possible risk factors were evaluated by univariate analysis and those found significant were entered into multivariate analysis. Results: RS were diagnosed in 31 patients (23.7 per 1000 person-years) of the ATV/r (n=465), and 4 (2.2 per 1000 person-years) of the other PIs (n=775). ATV/r use was significantly associated with RS by uni- and multivariate analyses (adjusted HR=10.4; 95% CI, 3.69-29.6; p<0.01). ATV/r remained a significant risk for RS in all subgroups stratified by the median values of baseline variables. In the 31 patients on ATV/r who developed RS, the median time from commencement of ATV/r to diagnosis was 24.5 months (IQR, 14.7-34.6 months). Of the 18 patients who continued ATV/r despite the diagnosis of RS, 6 (33.3%) experienced recurrence. No patient who discontinued ATV/r had recurrence during the observation period (250.6 person-months). Conclusions: The incidence of RS was substantially higher in patients on ATV/r than those on other PIs. Continuation of ATV/r after diagnosis of RS was associated with high rate of recurrence. Switching ATV/r to other ART is warranted in patients who develop RS.

Multivariate analysis to estimate the risk of ATV/r- over other PIs-containing ART
	Model 1 crude (n=1,240)	Model 2 adjusted (n=1,115)	Model 3 adjusted (n=1,115)
ATV/r use	HR (95%CI)	HR (95%CI)	HR (95%CI)
ATV/r use	10.44 (3.685-29.59)	9.339 (3.254-26.80)	10.08 (3.487-29.12)
Age per 1 year		1.012 (0.980-1.046)	1.002 (0.965-1.040)
Weight per 1 kg increment		0.980 (0.944-1.018)	0.965 (0.927-1.004)
Baseline eGFR per 10 ml/min/1.73m2 decrement			1.157 (0.968-1.382)
Baseline serum uric acid per 1mg/dl increment			1.423 (1.091-1.856)
Past exposure to indinavir			1.265 (0.415-3.859)


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