Previous studies have reported that protease inhibitors (PIs) can contribute to the glycaemic alterations however there are few trials about the direct effect of the single PI. The objective of the study was to evaluate the modifications of glucose and lipid profiles after the switch from lopinavir/ritonavir (LPV/r) to atazanavir, used as ritonavir-boosted (ATV/r) or un-boosted.

We conducted a retrospective observational cohort study about the effect of ATV/(r) on glycaemic metabolism (ATAGLU) in patients who switched from LPV/r with undetectable level of HIV-RNA. Totally 235 patients treated for 48 weeks with LPV/r plus 2NRTI and with undetectable HIV-RNA were included: 134 continued LPV/r after the initial 48 weeks, 101 switched to ATV(/r) (18.3% to ATV; 24.7% to ATV/r).

Significant decrease in mean glucose level and insulin resistance was observed in patients switched to ATV(/r). The mean cholesterol triglyceride levels increased in the LPV/r group and decreased among the patients who switched. A significant increase of CD4 T cells with undetectable levels of HIV-RNA was observed in all groups.

The long-term results obtained in this real-life study suggest that patients who have achieved initial suppression on a regimen including LPV/r + 2NRTI can switch to ATV/(r) + 2NRTI with an improvement of lipid and glycaemic metabolism.