[Efficacy of atazanavir in rescue therapy].
Virological failure of antiretroviral treatment increases the morbidity and mortality associated with AIDS. With currently available drugs it is possible to achieve an HIV - PVL < 50 copies of aRNA/mL in a significant percentage of patients with virological failure, even in those who accumulate a considerable number of resistant mutations in the viral genome. Compliance continues to be the most significant cause of antiretroviral treatment failure. Atazanavir boosted with ritonavir has clear advantages over other protease inhibitors (PI), such as its administration once per day, low number of tablets and a good tolerance which helps in compliance, as well as a lower metabolic toxicity and a resistances profile different to other PIs. Boosted Atazanavir in rescue treatments would be strongly recommended in patients naive to a PI or when there are < 3 mutations in the basic genotype in positions: 10F/I/V, 16E, 33I/F/V, 46I/L, 60E, 84V, 85 V and 90M of the protease gene, particularly when the patient has problems of compliance to antiretroviral treatment or metabolic disorders, such as dyslipaemia, insulin resistance, fasting blood glucose changes, a cardiovascular risk at 10 years of > 10% or cardiovascular disease.
Portilla
Joaquín
J
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, España. portilla-joa@gva.es
Boix
Vicente
V
Merino
Esperanza
E
Reus
Sergio
S
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D024882:Drug Resistance, Viral / Q000235:genetics; D004357:Drug Synergism; D050171:Dyslipidemias / Q000139:chemically induced / Q000150:complications; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D016333:HIV Protease / Q000235:genetics; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007333:Insulin Resistance; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010349:Patient Compliance; D017354:Point Mutation; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use; D016879:Salvage Therapy; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate; D016333:HIV Protease; C514803:p16 protease, Human immunodeficiency virus 1; D019438:Ritonavir