RESUMEN
OBJECTIVE: To evaluate the safety and virological response to lopinavir/ritonavir containing second-line therapy after failing a first line nonnucleoside reverse transcriptase inhibitor (NNRTI) based regimen. DESIGN: Prospective 36 months cohort study of patients switched to zidovudine/stavudine plus didanosine plus lopinavir/ritonavir capsules as second-line regimen. METHODOLOGY: Structured interview, medical examination, and laboratory assessment performed every 6 months. RESULTS: We enrolled 40 patients; 1 died and 3 were lost to follow-up. Median CD4+ count at baseline was 108 cell/microL, median log viral load was 4.8 copies/mL. Sixteen (40%) patients had baseline genotypic resistant test, 14 (87%) had lamivudine resistance mutations, and all had NNRTIs resistance mutations. At month 36, 82% of the patients achieved viral suppression (<400 copies/ mL) and the median increase in CD4+ count was 214 cell/microL, (interquartile range: 128-295). Twenty-five patients (62%) experienced at least one adverse event. CONCLUSIONS: Our study confirms lopinavir/ ritonavir-based second-line regimen but with a high rate of toxicities.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Estavudina/normas , Adulto , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/normas , Antirretrovirales/farmacología , Antirretrovirales/normas , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Didanosina/farmacología , Didanosina/normas , Didanosina/uso terapéutico , Farmacorresistencia Viral , Quimioterapia Combinada , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , VIH/efectos de los fármacos , VIH/genética , Infecciones por VIH/sangre , Humanos , Entrevistas como Asunto , Lopinavir , Masculino , Estudios Prospectivos , Pirimidinonas/farmacología , Pirimidinonas/normas , Pirimidinonas/uso terapéutico , Ritonavir/farmacología , Ritonavir/normas , Ritonavir/uso terapéutico , Estavudina/farmacología , Estavudina/uso terapéutico , Resultado del Tratamiento , Uganda , Carga Viral , Zidovudina/farmacología , Zidovudina/normas , Zidovudina/uso terapéuticoRESUMEN
Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment, and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis of treatment failure in most patients. However, operational research is needed to assess whether this strategy works in practice.