Comparing the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID‐19 patients

• Published in: Journal of medical virology Vol. 93; no. 12; pp. 6557 - 6565
• Main Authors: Kalantari, Saeed, Fard, Soheil R., Maleki, Donya, Taher, Mahshid T., Yassin, Zeynab, Alimohamadi, Yousef, Minaeian, Sara
• Format: Journal Article
• Language: English
• Published: London Wiley Subscription Services, Inc 01-12-2021; John Wiley and Sons Inc
• Subjects: Antibiotics; Antiretroviral drugs; Antiviral drugs; Atazanavir; Confidence intervals; Corticosteroids; COVID-19; Dolutegravir; Health services; Hydroxychloroquine; Laboratories; Lopinavir; Mortality; Pandemics; Parameters; Patients; Potassium; Potassium hydrides; Ritonavir; Thromboplastin; Virology
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.27195

The purpose of this study was to compare the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID‐19 patients based on clinical and laboratory parameters. We prospectively evaluated the clinical and laboratory outcomes of 62 moderate to severe COVID‐19 patients during a 10‐day treatment plan. Patients were randomly assigned to either KH (receiving Lopinavir/Ritonavir [Kaletra] plus Hydroxychloroquine) or ADH (receiving Atazanavir/Ritonavir, Dolutegravir, and Hydroxychloroquine) groups. During this period, clinical and laboratory parameters and outcomes such as intensive care unit (ICU) admission or mortality rate were recorded. Compared to the KH group, after the treatment period, patients in the ADH group had higher activated partial thromboplastin time (aPTT) (12, [95% confidence interval [CI]: 6.97, 17.06), p = <0.01), international normalized ratio (INR) (0.17, [95% CI: 0.07, 0.27), p = <0.01) and lower C‐reactive protein (CRP) (−14.29, (95% CI: −26.87, −1.71), p = 0.03) and potassium (−0.53, (95% CI: −1.03, −0.03), p = 0.04) values. Moreover, a higher number of patients in the KH group needed invasive ventilation (6 (20%) vs. 1 (3.1%), p = 0.05) and antibiotic administration (27 (90%) vs. 21(65.6), p = 0.02) during hospitalization while patients in the ADH group needed more corticosteroid administration (9 (28.1%) vs. 2 (6.7%), p = 0.03). There was no difference in mortality rate, ICU admission rate, and hospitalization period between the study groups. Our results suggest that the Atazanavir/Dolutegravir treatment regimen may result in a less severe disease course compared to the Lopinavir/Ritonavir treatment regimen and can be considered as an alternative treatment option beside standard care. However, to confirm our results, larger‐scale studies are recommended.
Highlights
Despite the use of many drugs and efforts in controlling the COVID‐19 pandemic, no definitive cure has been found yet.
We compared the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in hospitalized COVID‐19 patients.
Clinical and laboratory results show that Atazanavir/Dolutegravir regimen is more effective in ameliorating the severity of COVID‐19 and may be a useful addition to treatment options for COVID‐19 alongside standard care.