Recomendaciones de Gesida/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana (actualizacion febrero de 2009) / Recommendations from the GESIDA/Spanish AIDS Plan regarding antiretroviral treatment in adults with human immunodeficiency virus infection (update February 2009)

ABSTRACT

Objetivo Actualizar las recomendaciones sobre el tratamiento antirretroviral (TARV) para los adultos infectados por el virus de la inmunodeficiencia humana (VIH). Métodos Estas recomendaciones se han consensuado por un panel de expertos del Grupo de Estudio de Sida (Gesida) y del Plan Nacional sobre el Sida (PNS). Para ello se han revisado los avances en la fisiopatología del VIH, los resultados de eficacia y seguridad de ensayos clínicos, estudios de cohortes y de farmacocinética publicados en revistas biomédicas o presentados en congresos. Se han definido tres niveles de evidencia según la procedencia de los datos estudios aleatorizados (nivel A), de cohortes o de caso-control (nivel B) u opinión de expertos (nivel C). En cada una de las situaciones se ha establecido recomendar, considerar o no recomendar el TARV. Resultados El TARV con combinaciones de tres fármacos es el tratamiento de inicio (..) (AU)

ABSTRACT

Objective This consensus document is an update of antiretroviral therapy recommendations for adult patients with human immunodeficiency virus (HIV) infection. Methods To formulate these recommendations, a panel comprised of members of the Grupo de Estudio de Sida (Gesida, AIDS Study Group) and the Plan Nacional sobre el Sida (PNS, Spanish AIDS Plan) reviewed the advances in current understanding of the pathophysiology of HIV infection, and the efficacy and safety results from clinical trials, cohort studies, and pharmacokinetic studies published in biomedical journals or presented at scientific meetings over the last 2 years. Three levels of evidence were defined according to the data source randomized studies (level A), cohort or case-control studies (level B), and expert opinion (level C). The decision to recommend, consider, or not recommend antiretroviral therapy (ART) was established in each situation. Results The current treatment of choice for chronic HIV infection is a combination of 3 drugs from 2 different classes; that is, 2 nucleoside or nucleotide analogs (NRTI) plus 1 non-nucleoside (NNRTI) or 1 boosted protease inhibitor (PI/r). ART initiation is recommended in patients with symptomatic HIV infection. In asymptomatic patients, initiation of ART is recommended on the basis of CD4 lymphocyte counts, plasma viral load and the patient's comorbid conditions, as follows a) therapy should be started in patients with CD4 counts of<350cells/¦Ìl; b) when CD4 count is between 350 and 500cells/¦Ìl, therapy should be started in patients with chronic hepatitis C or cirrhosis, coinfection with hepatitis B requiring treatment, high cardiovascular risk, HIV nephropathy, HIV viral load >105copies/ml, or<14% CD4 cells; c) therapy should be deferred when CD4 count is >500cells/¦Ìl, but can be considered if any of the previous circumstances concur (AU)