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Boletín Médico del Hospital Infantil de México

2009, Número 4

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Bol Med Hosp Infant Mex 2009; 66 (4)


Respuesta discordante a terapia antirretroviral altamente activa en pacientes pediátricos mexicanos infectados con VIH/SIDA

Romano-Mazzotti L, Sifuentes-Vela C, Villalobos-Acosta P, Santos-Preciado JI, Pavía-Ruz N

Idioma: Español
Referencias bibliográficas: 28
Paginas: 335-342
Archivo PDF: 150.20 Kb.


RESUMEN

Introducción El objetivo de la terapia antirretroviral es lograr un descenso rápido de la carga viral y un aumento en el recuento de las células CD4. Sin embargo, en la respuesta discordante sólo se cumple uno de los objetivos de la terapia: disminución de la carga viral o aumento de linfocitos CD4.
Métodos. Estudio retrospectivo de pacientes pediátricos que acuden a la Clínica de Inmunodeficiencias del Hospital Infantil de México Federico Gómez. La respuesta inmunológica/virológica a terapia antirretroviral se clasificó en 4 clases: óptima, falla, respuesta discordante con éxito viral y respuesta discordante con fracaso viral. Se analizaron los datos demográficos y las determinaciones de carga viral y cuenta de linfocitos CD4 al ingreso, a los 6 y 12 meses posteriores al inicio del tratamiento.
Resultados. Se analizaron 56 pacientes, con edad promedio a su ingreso de 30.5 meses. La frecuencia de respuesta discordante al tratamiento, después de 6 y 12 meses fue de 45 y 53.5%, respectivamente.
Conclusión. La respuesta discordante en nuestra población pediátrica es mayor de 50%, similar a lo reportado en otros estudios pediátricos. A pesar de ser un escenario común, la repercusión clínica aún es incierta, por lo que este tipo de respuesta no debe de interpretarse, en primera instancia, como una mala respuesta a la terapia antirretroviral.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Starr SE, Fletcher CV, Spector SA, et al. Combination therapy with efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors in children infected with human immunodeficiency virus type 1. Pediatric AIDS Clinical Trials Group 382 Team. N Engl J Med. 1999; 341: 1874-81.

  2. Staszewski S, Morales-Ramírez J, Tashima KT, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999; 341: 1865-73.

  3. Working Group on Antiretroviral Therapy and Medical Management of HIV-infected children, United States. Health Resources and Services Administration. National Institutes of Health (U.S.). Guidelines for the use of antiretroviral agents in pediatric HIV infection. 2008 Junio 28; Bethesda, MD: National Institutes of Health; 2008.

  4. Mellors JW, Muñoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997; 126: 946-54.

  5. O’Brien WA, Hartigan PM, Daar ES, Simberkoff MS, Hamilton JD. Changes in plasma HIV RNA levels and CD4+ lymphocyte counts predict both response to antiretroviral therapy and therapeutic failure. VA Cooperative Study Group on AIDS. Ann Intern Med. 1997; 126: 939-45.

  6. Mehta SH, Lucas G, Astemborski J, Kirk GD, Vlahov D, Galai N. Early immunologic and virologic responses to highly active antiretroviral therapy and subsequent disease progression among HIV-infected injection drug users. AIDS Care. 2007; 19: 637-45.

  7. Nicastri E, Chiesi A, Angeletti C, et al. Clinical outcome after 4 years follow-up of HIV-seropositive subjects with incomplete virologic or immunologic response to HAART. J Med Virol. 2005; 76: 153-60.

  8. Ghaffari G, Passalacqua DJ, Caicedo JL, Goodenow MM, Sleasman JW. Two-year clinical and immune outcomes in human immunodeficiency virus-infected children who reconstitute CD4 T cells without control of viral replication after combination antiretroviral therapy. Pediatrics. 2004; 114: e604-11.

  9. Flynn PM, Rudy BJ, Douglas SD, et al. Virologic and immunologic outcomes after 24 weeks in HIV type 1-infected adolescents receiving highly active antiretroviral therapy. J Infect Dis. 2004; 190: 271-9.

  10. Sufka SA, Ferrari G, Gryszowka VE, et al. Prolonged CD4+ cell/virus load discordance during treatment with protease inhibitor-based highly active antiretroviral therapy: immune response and viral control. J Infect Dis. 2003; 187: 1027-37.

  11. Dronda F, Moreno S, Moreno A, Casado JL, Pérez-Elías MJ, Antela A. Long-term outcomes among antiretroviral-naive human immunodeficiency virus-infected patients with small increases in CD4+ cell counts after successful virologic suppression. Clin Infect Dis. 2002; 35: 1005-9.

  12. D’Ettorre G, Forcina G, Andreotti M, et al. Discordant response to antiretroviral therapy: HIV isolation, genotypic mutations, T-cell proliferation and cytokine production. AIDS. 2002; 16: 1877-85.

  13. Tan R, Westfall AO, Willig JH, et al. Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2008; 47: 553-8.

  14. Rodríguez C, Koch S, Goodenow M, Sleasman J. Clinical implications of discordant viral and immune outcomes following protease inhibitor containing antiretroviral therapy for HIV-infected children. Immunol Res. 2008; 40: 271-86.

  15. Tuboi SH, Brinkhof MW, Egger M, et al. Discordant responses to potent antiretroviral treatment in previously naive HIV-1-infected adults initiating treatment in resource-constrained countries: the antiretroviral therapy in low-income countries (ART-LINC) collaboration. J Acquir Immune Defic Syndr. 2007; 45: 52-9.

  16. Mehta S, Lucas G, Astemborski J, Kirk G, Vlahov D, Galai N. Early immunologic and virologic responses to highly active antiretroviral therapy and subsequent disease progression among HIV-infected injection drug users. CAIC. 2007; 19: 637-45.

  17. Schechter M. Discordant immunological and virological responses to antiretroviral therapy. J Antimicrob Chemother. 2006; 58: 506-10.

  18. Grabar S, Le Moing V, Goujard C, et al. Clinical outcome of patients with HIV-1 infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med. 2000; 133: 401-10.

  19. Moore DM, Hogg RS, Yip B, et al. Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy. J Acquir Immune Defic Syndr. 2005; 40: 288-93.

  20. Piketty C, Weiss L, Thomas F, Mohamed AS, Belec L, Kazatchkine MD. Long-term clinical outcome of human immunodeficiency virus-infected patients with discordant immunologic and virologic responses to a protease inhibitor-containing regimen. J Infect Dis. 2001; 183: 1328-35.

  21. Wu H, Lathey J, Ruan P, et al. Relationship of plasma HIV-1 RNA dynamics to baseline factors and virological responses to highly active antiretroviral therapy in adolescents (aged 12-22 years) infected through high-risk behavior. J Infect Dis 2004; 189: 593-601.

  22. Jankelevich S, Mueller BU, Mackall CL, et al. Long-term virologic and immunologic responses in human immunodeficiency virus type 1-infected children treated with indinavir, zidovudine, and lamivudine. J Infect Dis. 2001; 183: 1116-20.

  23. Malhotra A, Gaur S, Whitley-Williams P, Loomis C, Petrova A. Protease inhibitor associated mutations compromise the efficacy of therapy in human immunodeficiency virus-1 (HIV-1) infected pediatric patients: a cross-sectional study. AIDS Res Ther. 2007; 4: 15.

  24. Molinapinelo S, Leal M, Sorianosarabia N, et al. Prevalence and factors involved in discordant responses to highly active antiretroviral treatment in a closely followed cohort of treatment-naïve HIV-infected patients. J Clin Virol. 2005; 33: 110-5.

  25. National Institutes of Health (U.S.). Office of AIDS Research. Advisory Council, United States. Public Health Service. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents; 2008 Nov 3; Bethesda, MD: National Institutes of Health; 2008.

  26. Chen TK, Aldrovandi GM. Review of HIV antiretroviral drug resistance. Pediatr Infect Dis J. 2008; 27: 749-52.

  27. Resino S, Resino R, Leon J, et al. Impact of long-term viral suppression in CD4+ recovery of HIV-children on highly active antiretroviral therapy. BMC Infect Dis. 2006; 6: 10.

  28. Zhang F, Haberer JE, Zhao Y, et al. Chinese pediatric highly active antiretroviral therapy observational cohort: a 1-year analysis of clinical, immunologic, and virologic outcomes. J Acquir Immune Defic Syndr. 2007; 46: 594-8.




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