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Inhibidores de la proteasa del VIH-1. Una revisión para médicos clínicos

S G Deeks¹, M Smith, M Holodniy

¹University of California, San Francisco, USA.

|January 8, 1997

Resumen

Los inhibidores de la proteasa (IP) son cruciales para el tratamiento del virus de la inmunodeficiencia humana (VIH), ya que ofrecen una carga viral reducida y un aumento de los recuentos de CD4 +. La selección de pacientes para IPP requiere una cuidadosa consideración de la eficacia, la toxicidad y el costo.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Farmacología Farmacología.
Virología Virología.

Sus antecedentes:

El manejo de la infección por el virus de la inmunodeficiencia humana (VIH) ha sido transformado por los inhibidores de la proteasa (IP).
Hay cuatro IPI disponibles: el mesilato de saquinavir, el ritonavir, el sulfato de indinavir y el mesilato de nelfinavir.
No se disponía de estudios comparativos, lo que requería una evaluación de los datos existentes.

Objetivo del estudio:

Evaluar los datos disponibles sobre los inhibidores de la proteasa (IP) específicos del VIH.
Ayudar a los médicos y pacientes a seleccionar el tratamiento adecuado para el VIH.
Para proporcionar una visión general de la eficacia, la resistencia y el costo de los IP.

Principales métodos:

Revisión sistemática de las publicaciones revisadas por pares.
Incluye resúmenes de conferencias nacionales e internacionales.
Análisis de la información de registro de productos hasta septiembre de 1996.

Principales resultados:

El ritonavir, el indinavir y el nelfinavir logran niveles séricos sostenibles para la inhibición de la proteasa; el saquinavir no puede.
Se observó una reducción similar de la carga viral y un aumento de los linfocitos CD4 + con ritonavir, indinavir y nelfinavir; efectos menores con saquinavir.
El tratamiento con IP demostró una reducción de la progresión de la enfermedad por VIH y la mortalidad en estudios controlados con placebo; se observó resistencia genotípica y costos significativos.

Conclusiones:

Los inhibidores de la proteasa son críticos para el tratamiento del VIH, idealmente utilizados con inhibidores de la transcriptasa inversa.
La selección individualizada de PI es esencial, teniendo en cuenta la actividad, la toxicidad, la dosificación, las interacciones y el costo.
Mientras se desarrolla la resistencia, los IP pueden ser rentables al retrasar la progresión de la enfermedad y mejorar la calidad de vida.

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