Nandí LME, Ávila-Figueroa C

Idioma: Español
Referencias bibliográficas: 56
Paginas: 182-191
Archivo PDF: 123.95 Kb.

RESUMEN

El tratamiento de los pacientes pediátricos infectados con el virus de la inmunodeficiencia humana (VIH) ha cambiado enormemente en los últimos años. La terapia antirretroviral que incluye un inhibidor de proteasa ha resultado en beneficios virológicos, inmunológicos y clínicos como la disminución en la concentración viral plasmática, el aumento en el conteo de linfocitos CD4, la ganancia de peso, disminución de la incidencia de infecciones oportunistas, de hospitalizaciones relacionadas a la propia enfermedad, la reducción de la hepatoesplenomegalia, linfadenopatía y mejoría en la encefalopatía asociada a VIH, son comúnmente observados con el tratamiento.
A pesar del uso de terapia triple que incluye un inhibidor de proteasa (terapia antirretroviral altamente activa, TARAA), hay un número de pacientes con falla virológica causada por la resistencia viral y a la aparición de cepas mutantes. La inmadurez del sistema inmune, las diferencias en farmacocinética y farmacodinamia de los medicamentos antirretrovirales y los problemas concernientes a la adherencia al tratamiento, complica los resultados en los niños en comparación a los pacientes adultos. Para los pacientes que han fallado a una terapia antirretroviral triple con inhibidores de proteasa, aunque la experiencia es muy limitada, las guías de terapia antirretroviral recomiendan regímenes que contienen doble inhibidor de proteasa o que combinan un inhibidor de proteasa más un análogo no nucleósido como alternativa de tratamiento. Actualmente, las estrategias terapéuticas se deben enfocar al inicio temprano de una terapia capaz de suprimir al máximo la replicación viral, reducir el desarrollo de resistencia y preservar la función inmune.

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