Información del artículo
La simplificación de un tratamiento antirretroviral triple a lopinavir potenciado con ritonavir en monoterapia en pacientes con viremia controlada por períodos prolongados (más de 6 meses), y que no han fracasado previamente con un inhibidor de la proteasa, se ha postulado como una estrategia que podría disminuir la toxicidad y los costes del tratamiento antirretroviral a largo plazo, a la vez que mantiene intactas otras opciones terapéuticas. En la actualidad, disponemos de los resultados de varios estudios, algunos con un número elevado de pacientes y seguimientos de hasta 4 años, que nos permiten afirmar que la estrategia es eficaz y segura, lo que permite su utilización clínica cuando haya circunstancias que lo aconsejen. Esta estrategia puede ser especialmente útil para disminuir los costes de tratamiento en países con recursos económicos bajos.
Queda por definir el papel de esta estrategia en la prevención y el tratamiento de la lipodistrofia, y mejorar la capacidad de selección de los pacientes con un equilibrio de la relación riesgo-beneficio óptimo.
Palabras clave:
Lopinavir/ritonavir
Monoterapia
Tratamiento de simplificación
VIH-1
Inhibidores de la proteasa
Simplification of triple antiretroviral therapy to lopinavir/ritonavir (LPV/r) monotherapy in patients with well-controlled viremia for prolonged periods (more than 6 months) without prior failure with a protease inhibitor has been proposed as a strategy that could reduce the toxicity and costs of antiretroviral therapy in the long term while also preserving other therapeutic options. The results of several studies are currently available, some of which had a large number of patients and follow-up of up to 4 years.These studies indicate that this strategy is safe and efficacious, thus allowing its clinical use when indicated. This strategy may be especially useful in reducing the costs of treatment in countries with scarce economic resources. The role of LPV/r monotherapy in the prevention and management of lipodystrophy and in improving the selection of patients with an optimal riskbenefit ratio remains to be defined.
Key words:
Lopinavir/ritonavir
Monotherapy
Simplification therapy
HIV-1
Protease inhibitors
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