[Consensus statement on the clinical management of human immunodeficiency virus-associated neurocognitive disorders]. / Documento de consenso sobre el manejo clínico de los trastornos neurocognitivos asociados a la infección por el virus de la inmunodeficiencia humana (enero 2013).

OBJECTIVE: To develop a consensus document containing clinical recommendations for the management of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND). METHODS: We assembled a panel of experts appointed by GeSIDA and the Secretariat of the National AIDS Plan (PNS), including internal medicine physicians with expertise in the field of HIV, neuropsychologists, neurologists and neuroradiologists. Scientific information was reviewed to October 2012 in publications and conference papers. In support of the recommendations using two levels of evidence: the strength of the recommendation in the opinion of the experts (A, B, C) and the level of empirical evidence (I, II, III), two levels based on the criteria of the Infectious Disease Society of America, already used in previous documents GeSIDA/SPNS. RESULTS: Multiple recommendations for the clinical management of these disorders are provided, including two graphics algorithms, considering both the diagnostic and possible therapeutic strategies. CONCLUSIONS: Neurocognitive disorders associated with HIV infection is currently highly prevalent, are associated with a decreased quality of life and daily activities, and given the possibility of occurrence of an increase in the coming years, there is a need to adequately manage these disorders, from a diagnostic as well as therapeutic point of view, and always from a multidisciplinary perspective.

Utilidad de atazanavir en poblaciones especiales / Utility of atazanavir in special populations

En el momento actual, con el tratamiento antirretroviral (TAR) se consigue prolongar la supervivencia de las personas que viven con virus de la inmunodeficiencia humana (VIH) de forma indefinida. Debido a ello, nos encontramos cada vez con mayor frecuencia con problemas específicos que anteriormente no daba tiempo a desarrollar o no tenían la importancia que ahora alcanzan, y que configuran, a poblaciones especiales de pacientes. Ejemplos de situaciones que caracterizan a estas poblaciones especiales son: la coinfección por virus de la hepatitis B y/o C, el embarazo, la lipodistrofia, el riesgo cardiovascular, la insuficiencia renal, el tratamiento de los niños y adolescentes, la atención a personas desplazadas (inmigrantes) y el tratamiento de personas que estén recibiendo tratamiento sustitutivo con metadona, entre otras. En el presente artículo revisamos el papel que puede tener atazanavir en el TAR de pacientes en las situaciones mencionadas, excepto las que ya son tratadas específicamente en otros artículos, tal como la coinfección por virus de la hepatitis B y/o C

ART (antiretroviral therapy) currently continues to indefinitely prolong the survival of patients who live with HIV. Due to this, we are increasingly faced with specific problems that previously did not have time to develop or did not have the importance that they have now, and which are related to the existence of special patient populations. Examples of situations that characterise these special populations are: co-infection with hepatitis virus B and/or C, pregnancy, lipodystrophy, cardiovascular risk, renal failure, treatment of children and adolescents, immigrant health care, and the management of patients receiving methadone replacement therapy, among others. In this article we review the role that Atazanavir (ATV) can play in the ART of patients in the situations mentioned, except those that are already dealt with specifically in other articles, such as co-infection by hepatitis virus B and/or C

Seguridad y tolerabilidad de darunavir / Safety and tolerability of darunavir

Darunavir (DRV), previamente conocido como TMC-114, esun nuevo inhibidor de la proteasa (IP) con una alta afinidadpor la proteasa del VIH-1, y una gran capacidad para inhibirsu acción a pesar de que ésta experimente mutaciones,por lo que se considera que posee una gran potenciaintrínseca y una barrera genética muy elevada.En el momento de escribir esta monografía, los datos detolerabilidad y seguridad de DRV emergen, sobre todo, deestudios de rescate tardío (POWER, DUET), entre los quese han incluido a más de 1.600 pacientes. También haydatos recientes, con menor tiempo de evolución, deestudios en rescate precoz (TITAN) y de pacientes sintratamiento previo (ARTEMIS), entre los cuales amplían laexperiencia en más de 600 pacientes adicionales. Porúltimo, los más de 4.000 pacientes que han recibido DRV através del Programa de Acceso Expandido permitenconfigurar el perfil de tolerabilidad y seguridad de DRV,cuya impresión general es muy buena.En los estudios realizados hasta la fecha, DRV ha sido bientolerado, con mejor perfil que los IP utilizados en losgrupos control en efectos adversos como la diarrea, latolerabilidad gastrointestinal y las alteraciones en lasconcentraciones lipídicas. Además, hasta el momento no seha comunicado ningún efecto adverso grave inesperado(AU)

Darunavir, previously known as TMC-114, is a newprotease inhibitor (PI) with a high affinity for the HIV-1protease and strong ability to inhibit its action, even inmutated forms. Consequently, this drug is considered tohave great intrinsic potency and a high genetic barrier.At the time of writing, data on the tolerability and safety ofdarunavir come mainly from studies of late rescue therapy(POWER, DUET), which have included more than 1,600patients. Recent data, relating to shorter time periods, arealso available from studies in early treatment-experienced patients (TITAN) and in treatment–naïve patients (ARTEMIS),increasing experience to a further 600 patients. Lastly, morethan 4,000 patients who have received darunavir throughthe Expanded Access Program have allowed the drug’sgenerally good safety and tolerability profile to be defined.In the studies performed to date, darunavir has been welltolerated, with a better profile than that of the PIs used incontrol groups in terms of adverse effects such as diarrhea,gastrointestinal tolerability and lipid alterations. Moreover,to date, no unexpected severe adverse effects have beenreported(AU)

Seguridad y tolerabilidad de darunavir / Safety and tolerability of darunavir

Darunavir (DRV), previamente conocido como TMC-114, esun nuevo inhibidor de la proteasa (IP) con una alta afinidad por la proteasa del VIH-1, y una gran capacidad para inhibir su acción a pesar de que ésta experimente mutaciones, por lo que se considera que posee una gran potencia intrínseca y una barrera genética muy elevada.En el momento de escribir esta monografía, los datos detolerabilidad y seguridad de DRV emergen, sobre todo, deestudios de rescate tardío (POWER, DUET), entre los quese han incluido a más de 1.600 pacientes. También haydatos recientes, con menor tiempo de evolución, deestudios en rescate precoz (TITAN) y de pacientes sintratamiento previo (ARTEMIS), entre los cuales amplían laexperiencia en más de 600 pacientes adicionales. Porúltimo, los más de 4.000 pacientes que han recibido DRV através del Programa de Acceso Expandido permitenconfigurar el perfil de tolerabilidad y seguridad de DRV,cuya impresión general es muy buena.En los estudios realizados hasta la fecha, DRV ha sido bien tolerado, con mejor perfil que los IP utilizados en los grupos control en efectos adversos como la diarrea, la tolerabilidad gastrointestinal y las alteraciones en las concentraciones lipídicas. Además, hasta el momento no se ha comunicado ningún efecto adverso grave inesperado

Darunavir, previously known as TMC-114, is a newprotease inhibitor (PI) with a high affinity for the HIV-1 protease and strong ability to inhibit its action, even in mutated forms. Consequently, this drug is considered to have great intrinsic potency and a high genetic barrier. At the time of writing, data on the tolerability and safety of darunavir come mainly from studies of late rescue therapy (POWER, DUET), which have included more than 1,600 patients. Recent data, relating to shorter time periods, are also available from studies in early treatment-experienced patients (TITAN) and in treatment–naïve patients (ARTEMIS), increasing experience to a further 600 patients. Lastly, morethan 4,000 patients who have received darunavir throughthe Expanded Access Program have allowed the drug’sgenerally good safety and tolerability profile to be defined. In the studies performed to date, darunavir has been well tolerated, with a better profile than that of the PIs used in control groups in terms of adverse effects such as diarrhea, gastrointestinal tolerability and lipid alterations. Moreover, to date, no unexpected severe adverse effects have been reported

[Utility of atazanavir in special populations]. / Utilidad de atazanavir en poblaciones especiales.

ART (antiretroviral therapy) currently continues to indefinitely prolong the survival of patients who live with HIV. Due to this, we are increasingly faced with specific problems that previously did not have time to develop or did not have the importance that they have now, and which are related to the existence of special patient populations. Examples of situations that characterise these special populations are: co-infection with hepatitis virus B and/or C, pregnancy, lipodystrophy, cardiovascular risk, renal failure, treatment of children and adolescents, immigrant health care, and the management of patients receiving methadone replacement therapy, among others. In this article we review the role that Atazanavir (ATV) can play in the ART of patients in the situations mentioned, except those that are already dealt with specifically in other articles, such as co-infection by hepatitis virus B and/or C.

[Safety and tolerability of darunavir]. / Seguridad y tolerabilidad de darunavir.

Darunavir, previously known as TMC-114, is a new protease inhibitor (PI) with a high affinity for the HIV-1 protease and strong ability to inhibit its action, even in mutated forms. Consequently, this drug is considered to have great intrinsic potency and a high genetic barrier. At the time of writing, data on the tolerability and safety of darunavir come mainly from studies of late rescue therapy (POWER, DUET), which have included more than 1,600 patients. Recent data, relating to shorter time periods, are also available from studies in early treatment-experienced patients (TITAN) and in treatment-naïve patients (ARTEMIS), increasing experience to a further 600 patients. Lastly, more than 4,000 patients who have received darunavir through the Expanded Access Program have allowed the drug's generally good safety and tolerability profile to be defined. In the studies performed to date, darunavir has been well tolerated, with a better profile than that of the PIs used in control groups in terms of adverse effects such as diarrhea, gastrointestinal tolerability and lipid alterations. Moreover, to date, no unexpected severe adverse effects have been reported.