¿En qué momento y con qué combinaciones debería indicarse maraviroc en el nuevo escenario del tratamiento antirretroviral?

Leal, Manuel; Camacho, Ángela; Genebat, Miguel; Rivero, Antonio

doi:10.1016/S0213-005X(08)76562-5

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Maraviroc es un antagonista selectivo y lentamente reversible del correceptor CCR5 que ha mostrado una potente actividad antiviral in vitro frente a un amplio rango de aislados clínicos del VIH, incluidas las cepas multirresistentes a las 4 clases de fármacos antirretrovirales preexistentes. Maraviroc es activo frente a poblaciones del VIH que sólo utilizan el correceptor CCR5 para entrar en la célula, y no ha demostrado actividad significativa en el tratamiento de poblaciones virales que utilizan el correceptor CXCR4. El mecanismo de acción de maraviroc, no competitivo con el de otros fármacos antirretrovirales, y la ausencia de resistencia cruzada con el resto de familias de éstos han propiciado que maraviroc sea un fármaco posicionado para uso en terapia antirretroviral de rescate. Sin embargo, la excelente tolerancia de maraviroc, comparable con la del placebo en los ensayos clínicos en fase 3, su seguridad y su favorable perfil de interacciones farmacológicas con otros fármacos comúnmente usados en pacientes infectados por el VIH con comorbilidades hacen vislumbrar otros escenarios en los que el uso de maraviroc podría ser de utilidad.

Palabras clave:

Maraviroc

Antagonistas CCR5

VIH

Tratamiento antirretroviral

Maraviroc is a selective and slowly reversible antagonist of the CCR5 co-receptor which has shown to have powerful antiviral activity, in vitro, against a wide range of HIV clinical isolates, including strains multi-resistant to 4 classes of pre-existing antiretroviral drugs. Maraviroc is active against HIV populations that only use the CCR5 coreceptor to enter the cell and has not demonstrated significant activity in the treatment of viral populations that use the CXCR4 co-receptor. The mechanism of action of maraviroc, non-competitive with other antiretroviral drugs, and the absence of crossed resistance with the rest of their families, has led to Maraviroc being a drug available for use in rescue antiretroviral treatment. However, the excellent tolerance of maraviroc compared to the placebo in phase III clinical trials, its safety and its favourable pharmacological interactions profile with other drugs commonly used in HIV infected patients with comorbidity brings to light other scenarios in which Maraviroc could be useful.

Key words:

Maraviroc

CCR5 antagonists

HIV

Antiretroviral treatment

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