Información del artículo
El tratamiento antirretroviral (TAR) estándar consiste en la combinación de 3 fármacos activos y su elección varía considerablemente según el escenario clínico. El «estándar de oro» en los pacientes que inician TAR es tenofovir (TDF)/emtricitabina (FTC)/efavirenz. TDF/FTC también se consideran de elección cuando, por diversos motivos, se inicia TAR con un inhibidor de la proteasa potenciado. Abacavir y lamivudina (ABC/3TC) también se consideran de elección en la mayoría de guías terapéuticas. La determinación del HLA-B*5701 permite minimizar la posibilidad de hipersensibilidad a ABC y es un dato positivo para la utilización de ABC/3TC, pero deberá valorarse el impacto negativo que tendrán los estudios D:A:D y ACTG5202. TDF puede ser también una buena elección para sustituir a otro análogo de nucleósidos con el fin de evitar o revertir ciertas toxicidades en pacientes con buen control virológico. Con la sustitución de análogos de timidina por TDF se produce una mejoría del perfil lipídico y una recuperación parcial de grasa subcutánea. El perfil de resistencias de TDF permite que siga siendo un fármaco activo en la mayoría de pacientes con uno o incluso varios fracasos terapéuticos. TDF desempeña un papel especialmente importante en los pacientes coinfectados por virus hepatotropos. En definitiva, TDF es un fármaco muy utilizado en la práctica clínica debido a una excelente suma de eficacia, durabilidad y tolerabilidad, además de la comodidad que supone su administración en un solo comprimido al día, tanto si se administra en su formulación individual (Viread®), como asociado a FTC (Truvada®), o a FTC y efavirenz (Atripla®).
Palabras clave:
Tenofovir
Infección por VIH
Inicio de tratamiento antirretroviral
Simplificación de tratamiento antirretroviral
Tratamiento de rescate
Standard antiretroviral therapy (ART) consists of a combination of three active drugs. The selection of these drugs varies considerably according to the clinical scenario. The «gold standard» in patients initiating ART is tenofovir (TDF)/emtricitabine (FTC)/efavirenz. TDF/FTC is also considered a combination of choice when, for various reasons, ART is initiated with a boosted protease inhibitor. Abacavir and lamivudine (ABC/3TC) is also considered a combination of choice in most clinical practice guidelines. HLA-B*5701 determination minimizes the possibility of hypersensitivity to ABC and is a positive datum for the use of ABC/3TC. However, negative findings from the Data Collection on Adverse Events of Anti-HIV drugs (DAD) and ACTG5202 studies on this combination should be bourne in mind. TDF can also be a good choice for substituting another nucleoside analogue to avoid or reverse certain toxicities in patients with good virological control. Substituting thymidine analogues for TDF improves lipid profile and produces partial recuperation of subcutaneous fat. Because of the profile of resistance to TDF, this drug continues to be active in most patients with one, or even several, therapeutic failures. TDF plays an especially important role in patients coinfected with hepatotrophic viruses. In summary, TDF is a widely used drug in clinical practice due to its excellent combination of effectiveness, durability and tolerability, in addition to its ease of administration in a single daily dose, whether in its individual formulation (Viread®), or associated with FTC (Truvada®), or with FTC and efavirenz (Atripla®).
Key words:
Tenofovir
HIV infection
Initiation of antiretroviral therapy
Simplification of antiretroviral therapy
Rescue therapy
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