title: [Challenges of lopinavir/ritonavir in the chronicity of human immunodeficiency virus infection].
abstract: Combination antiretroviral therapy (ART) has increased patient survival, which is currently similar to that of the general population in western countries. However, ART is unable to completely restore normal health, given the persistence of chronic immune activation. Human immunodeficiency virus (HIV) infection has become a chronic disease and 50% of patients will soon be older than 50 years. Currently, there is a debate on the possibility of accelerated aging in the HIV-infected population. An overlap has been observed between chronic inflammation, age-related comorbidities, lifestyle, and the long-term toxicity of ART. ART-related toxicity can encourage the development of comorbidities, especially cardiovascular and renal complications, while toxicity-especially that of thymidine analogs-can also contribute to inflammation and aging. Evidence is available on simplification strategies with boosted protease inhibitor monotherapy aiming to avoid or reduce potential or demonstrated toxicity. Currently, studies are underway of dual therapy strategies with lopinavir/ritonavir (LPV/r) with distinct antiretroviral agents. The studies with the largest samples are those with raltegravir and lamivudine. The GARDEL trial has demonstrated that dual therapy with LPV/r plus a generic drug such as lamivudine is non-inferior to triple therapy in treatment- naïve patients. All of the above indicates the response to the challenge posed to LPV/r by the chronic phase of the disease and by the need to reduce costs.
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España. Electronic address: KOLDO.AGUIRREBENGOAIBARGUREN@osakidetza.net.
authors.forename: Koldo
authors.initials: K
authors.lastname: Aguirrebengoa
mesh_terms: D000375:Aging; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002908:Chronic Disease; D015897:Comorbidity; D004338:Drug Combinations; D016527:Drug Costs; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D019428:HIV Integrase Inhibitors / Q000627:therapeutic use; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D061466:Lopinavir / Q000009:adverse effects / Q000627:therapeutic use*; D055118:Medication Adherence; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations; D019428:HIV Integrase Inhibitors; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D019438:Ritonavir
keywords: Aging; Comorbidity; Comorbilidad; Envejecimiento; HIV infection; Infección VIH; Lopinavir