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El tratamiento con lopinavir potenciado con ritonavir (LPV/r) en monoterapia ha demostrado ser una alternativa eficaz, sobre todo en el mantenimiento de pacientes con tratamiento de combinación y supresión virológica prolongada. La monoterapia con LPV/r se asocia con un número mayor de episodios de viremia de nivel bajo, en comparación con el tratamiento de combinación, sin que en la mayoría de los casos se hayan detectado mutaciones de resistencia. La incidencia de aparición de mutaciones mayores de resistencia en los estudios OK piloto y OK04 ha sido muy baja: 0,51 por 100 pacientes-año, y ha estado relacionada principalmente con las mutaciones en posiciones 46, 54 y 82, que no han afectado a otras opciones terapéuticas. La contribución de mutaciones de resistencia de nivel bajo a la pérdida de control virológico parece limitada y, en todo caso, no parece diferente de lo observado para el tratamiento de combinación, aunque este fenómeno deberá estudiarse en ensayos más amplios a largo plazo.
Palabras clave:
VIH
Lopinavir
Monoterapia
Mutaciones de resistencia
Treatment with lopinavir/ritonavir (LPV/r) monotherapy has been shown to be an effective alternative, especially in the maintenance of patients previously treated with combination therapy and prolonged virological suppression. LPV/r monotherapy is associated with a greater number of low-level viremia episodes than combination therapy, without resistance mutations being detected in the majority of patients. The incidence of the development of major resistance mutations in the OK pilot and OK04 studies was very low: 0.51 per 100 patients-year, and was mainly related to mutations in positions 46, 54 and 82, which have not compromised other therapeutic options. The contribution of low-level resistance mutations to loss of virological control seems small, and no different from that observed in combination therapy. However, this phenomenon should be studied in larger, long-term trials.
Key words:
HIV
Lopinavir
Monotherapy
Resistance mutations
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