Portilla Joaquín, Boix Vicente, Merino Esperanza, Reus Sergio
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, España.
Enferm Infecc Microbiol Clin. 2008 Dec;26 Suppl 17:22-7. doi: 10.1016/S0213-005X(08)76616-3.
Virological failure of antiretroviral treatment increases the morbidity and mortality associated with AIDS. With currently available drugs it is possible to achieve an HIV - PVL < 50 copies of aRNA/mL in a significant percentage of patients with virological failure, even in those who accumulate a considerable number of resistant mutations in the viral genome. Compliance continues to be the most significant cause of antiretroviral treatment failure. Atazanavir boosted with ritonavir has clear advantages over other protease inhibitors (PI), such as its administration once per day, low number of tablets and a good tolerance which helps in compliance, as well as a lower metabolic toxicity and a resistances profile different to other PIs. Boosted Atazanavir in rescue treatments would be strongly recommended in patients naive to a PI or when there are < 3 mutations in the basic genotype in positions: 10F/I/V, 16E, 33I/F/V, 46I/L, 60E, 84V, 85 V and 90M of the protease gene, particularly when the patient has problems of compliance to antiretroviral treatment or metabolic disorders, such as dyslipaemia, insulin resistance, fasting blood glucose changes, a cardiovascular risk at 10 years of > 10% or cardiovascular disease.
抗逆转录病毒治疗的病毒学失败会增加与艾滋病相关的发病率和死亡率。使用目前可用的药物，即使在那些病毒基因组中积累了大量耐药突变的患者中，也有可能使相当比例的病毒学失败患者实现HIV - PVL < 50拷贝的aRNA/mL。依从性仍然是抗逆转录病毒治疗失败的最主要原因。利托那韦增强的阿扎那韦与其他蛋白酶抑制剂（PI）相比具有明显优势，例如每日给药一次、片剂数量少、耐受性良好有助于提高依从性，以及代谢毒性较低且耐药谱与其他PI不同。对于未使用过PI的患者，或者蛋白酶基因的基本基因型在10F/I/V、16E、33I/F/V、46I/L、60E、84V、85V和90M位置的突变数< 3个时，强烈推荐在挽救治疗中使用增强的阿扎那韦，特别是当患者存在抗逆转录病毒治疗依从性问题或代谢紊乱，如血脂异常、胰岛素抵抗、空腹血糖变化、10年心血管风险> 10%或患有心血管疾病时。
