medigraphic.com
ISSN 1561-3054 (Digital)

2021, Número 3

<< Anterior Siguiente >>

Rev Cubana Med Trop 2021; 73 (3)


Efectividad y seguridad de antirretrovirales para terapia de cambio en virus de la inmunodeficiencia humana

Millán VIC, Romero SD, Estrada-Orozco K

Idioma: Español
Referencias bibliográficas: 28
Paginas: 1-19
Archivo PDF: 535.44 Kb.


RESUMEN

Introducción: El aumento de la expectativa de vida en personas que viven con VIH ha obligado a buscar alternativas de terapia antiretroviral simplificadas y con menor potencial de toxicidad que favorezcan la adherencia, y con ello alcanzar metas de indetectabilidad de la carga viral. Varias alternativas se han propuesto en los últimos años y es necesario saber la efectividad de estas a mediano y largo plazo.
Objetivo: Determinar la efectividad y seguridad de la terapia de cambio, en pacientes mayores a 12 años que viven con el virus de la inmunodeficiencia humana.
Métodos: Se realizó la búsqueda de la literatura en bases de datos electrónicas y literatura gris. La medida de desenlaces para mantenimiento de carga viral (menos de 50 copias por mililitro), niveles de linfocitos T CD4+ y eventos adversos de la terapia de cambio frente a continuación de la terapia estándar se estimó de forma combinada.
Resultados: Se incluyeron seis ensayos clínicos aleatorizados que compararon terapia de cambio (Rilpivirina/Emtricitabina/Tenofovir alafenamida, Dolutegravir/Rilpivirina, Abacavir/Dolutegravir/Lamivudina), frente a la continuación de la terapia estándar. El mantenimiento de la carga viral no fue diferente entre los grupos (OR: 0,77; IC95% 0,59; 1,02), tampoco el recuento de linfocitos T CD4+ (DME: 6;76; IC95% -5,05;18,57), al igual que los eventos adversos serios (OR: 1,03; IC95% 0,74; 1,42).
Conclusiones: No se encontró diferencia en la efectividad y seguridad de la terapia de cambio frente a continuar la terapia estándar. Los resultados apoyan en uso de estas estrategias terapéuticas para favorecer la adherencia a la terapia antirretroviral.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. InfoSIDA. Afecciones relacionadas con el VIH / SIDA ¿Qué es una infección oportunista? [Internet]. 2019 p. 1-4. [acceso: 01/05/2020]. Available from: Available from: https://hivinfo.nih.gov/es/understanding-hiv/fact-sheets/que-es-una-infeccion-oportunista

  2. Shaw GM, Hunter E. HIV transmission. HIV AIDS A Found Nurs Healthc Pract. 2003;32-42..

  3. HIV Prevention [Internet]. [access: 19/05/2020]. Available from: Available from: www.cdc.gov/hiv/basics/prevention.html

  4. Centers for Disease Control and Prevention. Morbidity and Mortality. Weekly Report - Sexually Transmitted Diseases Treatment Guidelines. 2015 [access: 19/05/2020];51:199. Available from: Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm

  5. ONUSIDA. Hoja informativa - Últimas estadísticas sobre el estado de la epidemia de sida | ONUSIDA. [Internet]. 2019. p. 2018-20. [access: 05/05/2020]. Available from: Available from: https://www.unaids.org/es/resources/fact-sheet

  6. Departamento de Salud y Servicios Humanos. Tratamiento para la infección por el VIH [Internet]. infoSIDA. 2019 p. 1-4. [access: 20/11/2020]. Available from: Available from: https://infosida.nih.gov/understanding-hiv-aids/fact-sheets/21/51/tratamiento-para-la-infeccion-por-el-vih--conceptos-basicos

  7. Mateo-Urdiales A, Johnson S, Smith R, Nachega JB, Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database Syst Rev. 2019; 2019 (6).

  8. Iwuji C, Orne-Gliemann J, Balestre E, Larmarange J, Thiebaut R, Okesola N, et al. The impact of universal test and treat on HIV incidence in a rural South African population: ANRS 12249 TasP trial, 2012-2016. Aids[Internet]. 2016 [access: 19/05/2020]:2-4. Available from: Available from: http://programme.aids2016.org/Abstract/Abstract/10537

  9. WHO. HIV/AIDS - Treatment and care [Internet] 2007. [access: 15/05/2020]. Available from: Available from: https://www.who.int/hiv/topics/treatment/en/

  10. McCreesh N, Andrianakis I, Nsubuga RN, Strong M, Vernon I, McKinley TJ, et al. Universal test, treat, and keep: Improving ART retention is key in cost-effective HIV control in uganda. BMC Infect Dis [Internet]. 2017 [access: 19/05/2020];17(1):1-11. Available from: Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2420-y

  11. Cabrera S. Terapia Antirretroviral: cambios por toxicidad o simplificación (sin fracaso) [Internet]. 2017. p. 1-20. [access: 19/05/2020] Available from: Available from: http://www.infectologia.edu.uy/images/archivos/Terapia_Aantirretroviral_Julio2017.pdf

  12. Julian Higgins JT. Cochrane Handbook for Systematic Reviews of Interventions [Internet]. 2019 [access: 15/11/2020]. Available from: Available from: https://training.cochrane.org/handbook/current

  13. Urrutia G, Bonfill X. Declaración PRISMA [Internet]. Vol. 135, Medicina Clínica. 2010. p. 507-11. [access: 19/05/2020] Available from: Available from: http://es.cochrane.org/sites/es.cochrane.org/files/public/uploads/PRISMA_Spanish.pdf

  14. McMaster University. GradePro Guideline Development Tool [Internet]. 2020 [access: 20/01/2020]. Available from: Available from: https://gradepro.org/

  15. Hagins D, Orkin C, Daar ES, Mills A, Brinson C, DeJesus E, et al. Switching to coformulated rilpivirine (RPV), emtricitabine (FTC) and tenofovir alafenamide from either RPV, FTC and tenofovir disoproxil fumarate (TDF) or efavirenz, FTC and TDF: 96-week results from two randomized clinical trials. HIV Med [Internet]. 2018 Nov[access: 19/05/2020];19(10):724-33. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221083/

  16. DeJesus E, Ramgopal M, Crofoot G, Ruane P, LaMarca A, Mills A, et al. Switching from efavirenz, emtricitabine, and tenofovir disoproxil fumarate to tenofovir alafenamide coformulated with rilpivirine and emtricitabine in virally suppressed adults with HIV-1 infection: a randomised, double-blind, multicentre, phase 3b, non-i. Lancet HIV[Internet]. 2017 May[access: 19/05/2020];4(5):e205-13. Available from: Available from: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30032-2/fulltext

  17. Orkin C, DeJesus E, Ramgopal M, Crofoot G, Ruane P, LaMarca A, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide coformulated with rilpivirine and emtricitabine in virally suppressed adults with HIV-1 infection: a randomised, double-blind, multicentre, phase 3b, non-inferiority study. Lancet HIV. 2017;4(5):e195-204.

  18. Aboud M, Orkin C, Podzamczer D, Bogner JR, Baker D, Khuong-Josses MA, et al. Efficacy and safety of dolutegravir-rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies. Lancet HIV [Internet]. 2019;6(9):e576-87. Doi: http://dx.doi.org/10.1016/S2352-3018(19)30149-3

  19. Trottier B, Lake JE, Logue K, Brinson C, Santiago L, Brennan C, et al. Dolutegravir/abacavir/lamivudine versus current ART in virally suppressed patients (STRIIVING): a 48-week, randomized, non-inferiority, open-label, Phase IIIb study. Antivir Ther[Internet]. 2017 [access: 19/05/2020];22(4):295-305. Available from: Available from: https://www.intmedpress.com/journals/avt/article.cfm?id=3166&pid=48&sType=AVT

  20. Arribas JR, Pialoux G, Gathe J, Di Perri G, Reynes J, Tebas P, et al. Simplification to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus continuation of ritonavir-boosted protease inhibitor with emtricitabine and tenofovir in adults with virologically suppressed HIV (STRATEGY-PI): 48 week results o. Lancet Infect Dis [Internet]. 2014;14(7):581-9. Doi: http://dx.doi.org/10.1016/S1473-3099(14)70782-0

  21. Campo RE, Cohen C, Grimm K, Shangguan T, Maa J, Seekins D. Switch from protease inhibitor- to efavirenz-based antiretroviral therapy improves quality of life, treatment satisfaction and adherence with low rates of virological failure in virologically suppressed patients. Int J STD AIDS [Internet]. 2010 Mar;21(3):166-71. Doi: https://doi.org/10.1258/ijsa.2009.008487

  22. Pozniak A, Markowitz M, Mills A, Stellbrink HJ, Antela A, Domingo P, et al. Switching to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus continuation of non-nucleoside reverse transcriptase inhibitor with emtricitabine and tenofovir in virologically suppressed adults with HIV (STRATEGY-NNRTI): 48 week r. Lancet Infect Dis [Internet]. 2014;14(7):590-9. Doi: http://dx.doi.org/10.1016/S1473-3099(14)70796-0

  23. Baril J, Conway B, Giguère P, Ferko N, Hollmann S, Angel JB. A meta-analysis of the efficacy and safety of unboosted atazanavir compared with ritonavir-boosted protease inhibitor maintenance therapy in HIV-infected adults with established virological suppression after induction. HIV Med [Internet]. 2014;15(5):301-10. Doi: https://doi.org/10.1111/hiv.12118

  24. Campo R, DeJesus E, Bredeek UF, Henry K, Khanlou H, Logue K, et al. SWIFT: Prospective 48-week study to evaluate efficacy and safety of switching to emtricitabine/tenofovir from lamivudine/abacavir in virologically suppressed hiv-1 infected patients on a boosted protease inhibitor containing antiretroviral regimen. Clin Infect Dis. 2013;56(11):1637-45.

  25. Cruciani M, Mengoli C, Serpelloni G, Parisi SG, Malena M, Bosco O. Abacavir-based triple nucleoside regimens for maintenance therapy in patients with HIV. Cochrane database Syst Rev [Internet]. Jun 2013 [access: 19/05/2020];(6):CD008270. Available from: Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008270.pub2/full

  26. ONUSIDA. Un ambicioso objetivo de tratamiento para contribuir al fin de la epidemia de sida [Internet]. Unaids.Org. 2013. p. 39. [access: 05/05/2020]. Available from: Available from: https://www.unaids.org/sites/default/files/media_asset/90_90_90_es.pdf

  27. Organización Mundial de la Salud. Estrategia Mundial Del Sector De La Salud Contra El Vih 2016-2021 Hacia El Fin Del Sida. OMS [Internet]. 2016. p. 1-59. [access: 19/05/2020] Available from: Available from: https://apps.who.int/iris/bitstream/handle/10665/250574/WHO-HIV-2016.05-spa.pdf;jsessionid=F55585494601D2837BDD489C605C7496?sequence=1

  28. Fabbiani M, Mondi A, Colafigli M, D'ettorre G, Paoletti F, D'avino A, et al. Safety and efficacy of treatment switch to raltegravir plus tenofovir/emtricitabine or abacavir/lamivudine in patients with optimal virological control: 48-week results from a randomized pilot study (Raltegravir Switch for Toxicity or Adverse Events, RAST. Scand J Infect Dis [Internet]. 2014 [access: 19/05/2020];46(1):34-45. Available from: Available from: https://www.tandfonline.com/doi/abs/10.3109/00365548.2013.840920?journalCode=infd19




2020     |     www.medigraphic.com