HIV-protease inhibitor atazanavir in the schemes of the first line of antiretroviral therapy
The article is concerned with the results of the CASTLE study, which compared the efficacy and safety of two antiretroviral treatment regimens, including 2 nucleoside reverse transcriptase inhibitor (NRTI): tenofovir (TDF) and emtricitabine (FTC), as well as "enhanced" protease inhibitor (PI) HIV – atazanavir/ritonavir (ATV/r) or lopinavir/ ritonavir (LPV/r) in 883 patients with HIV infection who have not previously received ART. After 96 weeks of treatment virological efficacy of the treatment regimen based on ATV/r was somewhat higher (particularly in patients with initially low number of CD4-lymphocytes) than the treatment regimen based on LPV/r, because the proportion of patients dropped out of a study was higher in case the latest regimen application. Immunological efficacy of two ART regimens was also comparable. The frequency of virological treatment failure was low in both groups of patients, and the development of HIV resistance (mainly to the FTC) was recorded only in few patients. Both ART regimens were well tolerable, however, the frequency of gastrointestinal disorders was significantly lower in patients treated with ATV/r. Application of the ARV regimen based on ATV/r has a much smaller effect on blood lipid parameters. The CASTLE study conclusively showed that ARV treatment regimen with TDF/FTC and ATV/r administration once a day is the therapy of choice in patients with HIV infection treated with ART for the first time.

Keywords: immunological efficacy, virological efficacy, lopinavir/ritonavir, atazanavir/ritonavir, antiretroviral therapy, HIV infection