title: [Lopinavir/ritonavir in patients with human immunodeficiency virus infection in special situations].
abstract: Ritonavir-boosted lopinavir (LPV/r) is a protease inhibitor used for the treatment of human immunodeficiency virus (HIV) infection in both normal patients and in certain situations. In patients with renal failure, LPV/r does not require dosage adjustment because it is metabolized in the liver. Cohort studies have shown that the incidence of varying degrees of renal disease and/or crystalluria related to combination antiretroviral therapy with tenofovir and some protease inhibitors (PI) does not appear with LPV/r or that the incidence is much lower with this combination. Neurocognitive impairments are described in a high proportion of patients with HIV infection and viral replication or related inflammatory activity in the subarachnoid space. In these patients, LPV/r is one of the therapeutic options. A score has been published that rates antiretroviral drugs according to the concentration attained in the cerebrospinal fluid (CSF). LPV/r levels reached in CSF exceed the IC50 of wild-type HIV and has a valuable score (score 3) of the drugs currently used. The most important comorbid condition is chronic hepatitis, due to its frequency and because the biotransformation of LPV/r occurs in the liver. In these circumstances, it is important to evaluate the influence of liver failure on blood drug levels and how these values may cause liver toxicity. LPV/r dose modification has not been established in the presence of liver failure. LPV/r-induced liver toxicity has only been reported with a certain frequency when liver enzymes were elevated at baseline or in patients with chronic hepatitis C, although most cases of liver toxicity were mild.
authors.affiliation: Unidad de Enfermedades Infecciosas y Servicio de Medicina Interna, Hospital Universitario La Fe, Valencia, España.
authors.forename: María
authors.initials: M
authors.lastname: Tasias
authors.affiliation: Unidad de Enfermedades Infecciosas y Servicio de Medicina Interna, Hospital Universitario La Fe, Valencia, España. Electronic address: pepelopezal@gmail.com.
authors.forename: José López
authors.initials: JL
authors.lastname: Aldeguer
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D004338:Drug Combinations; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019428:HIV Integrase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015497:HIV-1; D015498:HIV-2; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D061466:Lopinavir / Q000008:administration & dosage / Q000009:adverse effects / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000139:chemically induced / Q000150:complications / Q000378:metabolism; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013346:Subarachnoid Space / Q000821:virology
chemical_list: 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: Alteraciones neurocognitivas; Coinfección con virus de la hepatitis C; HIV-1; HIV-2; Hepatitis C virus co-infection; Inhibidores de la proteasa; Insuficiencia renal; Lopinavir; Neurocognitive impairment; Protease inhibitors; Renal failure; Ritonavir; VIH-1; VIH-2