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Atazanavir (ATV) es un inhibidor de la proteasa (IP) cuyas principales cualidades en comparación con los otros IP son la cómoda dosificación, la buena tolerabilidad y el excelente perfil metabólico. Estas características hacen que se asemeje más a un no nucleósido que a un IP, pero con la elevada barrera genética propia de los IP. Está indicado en el tratamiento inicial, en la simplificación del tratamiento o el cambio por toxicidad, y en las primeras líneas de rescate. En Europa se ha aprobado la administración de ATV potenciado con ritonavir (300/100 mg/día) en todos los escenarios clínicos. En pacientes naïve se ha combinado con prácticamente todas la parejas de análogos de los nucleósidos y ha demostrado ser tan eficaz como lopinavir/ritonavir e incluso como efavirenz. En Estados Unidos, esta indicación está aprobada desde hace casi 5 años y ATV se ha convertido en el IP más prescrito, mientras que la Asociación Europea del Medicamento (EMEA) la ha aprobado este año. ATV es un fármaco óptimo para sustituir a otros antirretrovirales en estrategias de simplificación o cambios por toxicidad. En varios estudios se ha demostrado que en pacientes con buen control virológico puede sustituir a lopinavir/r o a otro IP, manteniéndose la eficacia terapéutica, con una excelente tolerabilidad y una mejoría del perfil lipídico, y con una disminución del riesgo cardiovascular. Esta estrategia es ampliamente utilizada en España. En este escenario, algunos pacientes podrían beneficiarse del tratamiento con ATV no potenciado (400 mg/día). ATV es una opción eficaz y muy atractiva en las primeras líneas de rescate en que el virus muestra escasa o nula resistencia a los IP, pues su simplicidad y tolerabilidad pueden mejorar los problemas de adhesión, principal causa de los fracasos terapéuticos. En pacientes con resistencia moderada a los IP, ATV es tan eficaz como LPV/r. La supervivencia de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) es cada vez más prolongada y cobran mayor importancia factores como la tolerabilidad, el riesgo cardiovascular y la adaptabilidad del tratamiento a la vida del paciente, por lo cual ATV debe desempeñar un importante papel en el tratamiento de la infección por el VIH.
Palabras clave:
Atazanavir
Inhibidores de la proteasa
Infección por el VIH
Tratamiento inicial
Simplificación de tratamiento
Tratamiento de rescate
Atazanavir (ATV) is a protease inhibitor (PI) in which its main qualities, compared to other PI are dosing convenience, good tolerability and excellent metabolic profile. These characteristics makes it more like a nonnucleoside than a PI, but with the increased genetic barrier common to PI. It is indicated in initial treatment, simplification treatment or a change due to toxicity and in first line rescue treatment. The administering of ATV boosted with ritonavir (300/100 mg/d) has been approved in Europe in all clinical situations. In naïve patients it has been combined with practically all the nucleoside analogue pairs and has shown to be as effective as lopinavir/ritonavir and even efavirenz. In the USA, this indication has been approved for almost 5 years and ATV has become the most prescribed PI, while the EMEA has approved it this year. ATV is an optimal drug to replace other antiretrovirals in simplification strategies or changes due to toxicity. In several studies it has been shown that, in patients with good virological control, it can LPV/r or another PI, the therapeutic efficacy being maintained, with excellent tolerance and an improved lipid profile, and decreasing the cardiovascular risk. This strategy is widely used in Spain. In this scenario some patients could benefit from non-boosted ATV treatment (400 mg/d). ATV is an effective and very attractive option in first line rescue treatments in which the virus shows little or no resistance to PI, as its simplicity and tolerability can improve problems with compliance, the main cause of therapeutic failure. In patients with moderate resistance to PI, ATV is as effective as LPV/r. The survival of patients with HIV infection is increasingly longer and factors such as tolerability, cardiovascular risk and the adaptability of the treatment to the lifestyle of the patient, become more important, therefore ATV must play an important role in the treatment of HIV-infection.
Key words:
Atazanavir
Protease inhibitors
HIV infection
Initial treatment
Simplification treatment
Rescue treatment
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