Rivero Antonio, Camacho Angela, Pérez-Camacho Inés, Torre-Cisneros Julián
Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, España.
Enferm Infecc Microbiol Clin. 2008 Dec;26 Suppl 17:45-8. doi: 10.1016/S0213-005X(08)76620-5.
Atazanavir is a protease inhibitor indicated, in combination with other antiretrovirals, as an initial treatment of HIV infection or in previously treated patients. Antiretroviral treatment based on atazanavir has been associated with a low incidence of hepatotoxicity, both in Clinical Trials as well as in cohort studies. However, the finding of hyperbilirubinaemia has been common in these studies, although it usually does not involve withdrawing the treatment. In patients co-infected with hepatitis B or C, the level of virological response to does not appear to be affected and the incidence of adverse effects, except the higher incidence of hepatotoxicity, is no higher than in non-coinfected subjects. The incidence of severe hepatotoxicity (grade 3-4) in patients coinfected by HIV and HVC who receive drug combinations that contain atazanavir is 6%. Atazanavir has a favourable tolerance and safety profile in patients coinfected with hepatitis virus even in the presence of significant fibrosis. The lower association of atazanavir with the development of insulin resistance, a fact that has been associated with increasing the progression to hepatic fibrosis and lower treatment response rates, could be an added benefit of the use atazanavir in coinfected patients and could serve as an additional argument for its use in these patients.
阿扎那韦是一种蛋白酶抑制剂，与其他抗逆转录病毒药物联合使用，可作为HIV感染的初始治疗药物，也可用于既往接受过治疗的患者。在临床试验和队列研究中，基于阿扎那韦的抗逆转录病毒治疗与肝毒性发生率较低相关。然而，在这些研究中，高胆红素血症的发现很常见，尽管通常不需要停止治疗。在合并感染乙型或丙型肝炎的患者中，病毒学反应水平似乎不受影响，除肝毒性发生率较高外，不良反应发生率并不高于未合并感染的受试者。接受含阿扎那韦药物组合治疗的HIV和丙型肝炎病毒合并感染患者中，严重肝毒性（3-4级）的发生率为6%。即使存在明显纤维化，阿扎那韦在合并感染肝炎病毒的患者中也具有良好的耐受性和安全性。阿扎那韦与胰岛素抵抗发展的关联较低，胰岛素抵抗与肝纤维化进展加快和治疗反应率降低有关，这可能是阿扎那韦在合并感染患者中使用的额外益处，也可作为在这些患者中使用该药的另一个理由。
