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El fracaso del tratamiento y los factores de mortalidad en pacientes que reciben terapia de segunda línea contra el

Mar Pujades-Rodríguez¹, Suna Balkan, Line Arnould

¹Epicentre, Médecins Sans Frontières 42-bis, Bd, 8 rue Saint Sabin, 75011 Paris, France. mar.pujades@epicentre.msf.org

|July 20, 2010

Resumen

El fracaso de la terapia antirretroviral de segunda línea (TAR) en pacientes con VIH en África y Asia está relacionado con bajos recuentos de CD4, regímenes subóptimos y poca adherencia. El fracaso del tratamiento aumenta significativamente el riesgo de mortalidad en estas poblaciones.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Salud Pública La salud pública.
Investigación sobre el VIH/SIDA Investigación sobre el VIH/SIDA

Sus antecedentes:

El uso a largo plazo de la terapia antirretroviral (TAR) conduce a una mayor necesidad de tratamiento de segunda línea para el VIH en entornos con recursos limitados.
Las opciones terapéuticas limitadas requieren una evaluación de la eficacia del régimen de segunda línea.

Objetivo del estudio:

Investigar las tasas de fracaso en pacientes en terapia de VIH de segunda línea.
Identificar los factores asociados con el fracaso del tratamiento y la mortalidad.

Principales métodos:

Estudio multicorporal de 632 pacientes adultos en 27 programas de TAR en África y Asia (2001-2008).Estudio multicorporal de 632 pacientes adultos en 27 programas de TAR en África y Asia (2001-2008).Estudio multicorporal de 632 pacientes adultos en 27 programas de TAR en África y Asia (2001-2008).Estudio multicorporal de 632 pacientes adultos en 27 programas de TAR en África y Asia (2001-2008).
Se evaluaron las tasas de fallo clínico, inmunológico y virológico y la mortalidad.
Los análisis de sensibilidad utilizaron umbrales alternativos de CD4 y definiciones para el desgaste de cohorte.

Principales resultados:

El 18,8% de los pacientes cumplió con los criterios de fracaso de la OMS; el 5,4% murió.
Se observaron tasas de fracaso más altas con recuentos CD4 más bajos al inicio del tratamiento y una menor adherencia.
Se observaron tasas de fracaso más bajas al cambiar dos inhibidores nucleosídicos de la transcriptasa inversa (INTR) frente a uno.
La mortalidad fue más alta en pacientes con fracaso del tratamiento y más baja en mujeres.

Conclusiones:

El fracaso del tratamiento en la terapia de segunda línea contra el VIH se asocia con un recuento basal bajo de CD4, regímenes subóptimos y poca adherencia.
El diagnóstico de fracaso del tratamiento es un predictor significativo de la mortalidad.
Los hallazgos destacan la necesidad de estrategias de segunda línea optimizadas y apoyo a la adherencia.

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