Perfil lipídico e inhibidores de integrasa: revisión sistemática y metaanálisis

Autores/as

DOI:

https://doi.org/10.21615/cesmedicina.6017

Palabras clave:

VIH, Inhibidores de integrasa, Colesterol, Dislipidemias, Revisión sistemática

Resumen

Introducción: en pacientes con virus de inmunodeficiencia humana algunos antirretrovirales afectan el perfil lipídico incrementando el riesgo cardiovascular. Hay evidencia de que los inhibidores de integrasa afectan poco al perfil lipídico. El presente estudio buscó evaluar la mejor evidencia disponible sobre cambios en lípidos de pacientes con virus de inmunodeficiencia humana que cambiaron su terapia antirretroviral a esquemas con inhibidores de integrasa. Métodos: revisión sistemática de la literatura con intención metaanalítica. A partir de la pregunta: “En pacientes mayores de 16 años con virus de inmunodeficiencia humana, los esquemas antirretrovirales que incluyen inhibidores de integrasa comparados con aquellos esquemas antirretrovirales que no los incluyen, ¿presentan cambios en el perfil lipídico?” se extrajeron palabras clave para búsqueda de la evidencia publicada entre 1997 y diciembre 2019. Se incluyeron estudios experimentales y observacionales y su calidad fue evaluada. Se realizó análisis por inhibidor de integrasa y parámetro lipídico buscándose síntesis cuantitativa de la evidencia. Resultados: se identificaron 17 estudios relevantes susceptibles de síntesis de la evidencia con un total de 5 683 pacientes. De estos, 2 878 entraron a síntesis cuantitativa. Acorde a lo encontrado, los inhibidores de integrasa presentan mejor perfil lipídico comparados a otros antirretrovirales. Dolutegravir fue el que mostró mejor perfil lipídico cuando la comparación se hizo con inhibidores de proteasa. Raltegravir tuvo mejor perfil lipídico comparándolo con inhibidores de transcriptasa inversa no análogos de nucleósidos. Conclusiones: el uso de inhibidores de integrasa es un factor relevante en el control del riesgo cardiovascular en pacientes con virus de inmunodeficiencia humana.

Descargas

Los datos de descargas todavía no están disponibles.

Referencias bibliográficas

Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS. 2016

Silverberg MJ, Leyden WA, Xu L, Horberg MA, Chao CR, Towner WJ, et al. Immunodeficiency and risk of myocardial infarction among HIV-positive individuals with access to care. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2014;65(2):160–6.

Freiberg MS, Chang C-CH, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Internal Medicine. 2013;173(8):614–22.

Hsue PY, Waters DD. HIV infection and coronary heart disease: mechanisms and management. Nat Rev Cardiol. 2019;16(12):745–59.

Ryom L, Lundgren JD, El-Sadr W, Reiss P, Kirk O, Law M, et al. Cardiovascular disease and use of contemporary protease inhibitors: the D: A: D international prospective multicohort study. The lancet HIV. 2018;5(6):e291–300.

Lundgren J, Mocroft A, Ryom L. Contemporary protease inhibitors and cardiovascular risk. Curr Opin Infect Dis. 2018;31(1):8–13.

Snedecor SJ, Radford M, Kratochvil D, Grove R, Punekar YS. Comparative efficacy and safety of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: a systematic review and network meta-analysis. BMC Infect Dis. 2019;19(1):484.

European AIDS Clinical Society. EACS Guidelines 10.0. 2019.

Patel DA, Snedecor SJ, Tang WY, Sudharshan L, Lim JW, Cuffe R, et al. 48-Week Efficacy and Safety of Dolutegravir Relative to Commonly Used Third Agents in Treatment-Naive HIV-1–Infected Patients: A Systematic Review and Network Meta-Analysis. PLoS One [Internet]. 2014 [citado 13 de mayo de 2020];9(9). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154896/

Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology. 2014;14(1):135.

Ankit Rohatgi. WebPlotDigitizer [Internet]. San Francisco, California, USA; 2019. Disponible en: https://automeris.io/WebPlotDigitizer

Campbell M, Katikireddi SV, Sowden A, McKenzie JE, Thomson H. Improving Conduct and Reporting of Narrative Synthesis of Quantitative Data (ICONS-Quant): protocol for a mixed methods study to develop a reporting guideline. BMJ open. 2018;8(2):e020064.

De Castro N, Braun J, Charreau I, Pialoux G, Cotte L, Katlama C, et al. Switch from enfuvirtide to raltegravir in virologically suppressed multidrug-resistant HIV-1-infected patients: a randomized open-label trial. Clin Infect Dis. 2009;49(8):1259–67.

Lake JE, McComsey GA, Hulgan TM, Wanke CA, Mangili A, Walmsley SL, et al. A randomized trial of raltegravir replacement for protease inhibitor or non-nucleoside reverse transcriptase inhibitor in HIV-infected women with lipohypertrophy. AIDS Patient Care STDs. 2012;26(9):532–40.

Eron JJ, Young B, Cooper DA, Youle M, Dejesus E, Andrade-Villanueva J, et al. Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-based regimen in stable HIV-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre, double-blind, randomised controlled trials. Lancet. de 2010;375(9712):396–407.

La Rosa AM, Harrison LJ, Taiwo B, Wallis CL, Zheng L, Kim P, et al. Raltegravir in second-line antiretroviral therapy in resource-limited settings (SELECT): a randomised, phase 3, non-inferiority study. Lancet HIV. 2016;3(6):e247-258.

van Lunzen J, Pozniak A, Gatell JM, Antinori A, Klauck I, Serrano O, et al. Brief Report: Switch to Ritonavir-Boosted Atazanavir Plus Raltegravir in Virologically Suppressed Patients With HIV-1 Infection: A Randomized Pilot Study. J Acquir Immune Defic Syndr. 2016;71(5):538–43.

Boyd MA, Kumarasamy N, Moore CL, Nwizu C, Losso MH, Mohapi L, et al. Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of. Lancet. 2013;381(9883):2091–9.

Amin J, Boyd MA, Kumarasamy N, Moore CL, Losso MH, Nwizu CA, et al. Raltegravir non-inferior to nucleoside based regimens in second-line therapy with lopinavir/ritonavir over 96 weeks: a randomised open label study for the treatment of HIV-1 infection. PLoS One. 2015;10(2):e0118228.

Kozal MJ. A Pilot Randomized, Open-Label Study Comparing the Safety and Efficacy of a Raltegravir Based NRTI Sparing Regimen [Internet]. clinicaltrials.gov; 2016 ene [citado 18 de febrero de 2021]. Report No.: NCT00814879. Disponible en: https://clinicaltrials.gov/ct2/show/NCT00814879

Ofotokun I, Sheth AN, Sanford SE, Easley KA, Shenvi N, White K, et al. A switch in therapy to a reverse transcriptase inhibitor sparing combination of lopinavir/ritonavir and raltegravir in virologically suppressed HIV-infected patients: a pilot randomized trial to assess efficacy and safety profile: the KITE study. AIDS Res Hum Retroviruses. 2012;28(10):1196–206.

Gupta SK, Mi D, Moe SM, Dube MP, Liu Z. Effects of switching from efavirenz to raltegravir on endothelial function, bone mineral metabolism, inflammation, and renal function: a randomized, controlled trial. J Acquir Immune Defic Syndr. 2013;64(3):279–83.

Calza L, Magistrelli E, Colangeli V, Borderi M, Bussini L, Bon I, et al. Substitution of nevirapine or raltegravir for protease inhibitor vs. rosuvastatin treatment for the management of dyslipidaemia in HIV-infected patients on stable antiretroviral therapy (Nevrast study). Infect Dis. 2017;49(10):737–47.

Olalla J, Del Arco A, de la Torre J, Salas D, Prada JL, García-Alegría J. Raltegravir en pacientes con infección por el virus de la inmunodeficiencia humana y alto riesgo vascular. Med Clin (Barc). 2012;138(3):107–9.

Gatell JM, Assoumou L, Moyle G, Waters L, Johnson M, Domingo P, et al. Switching from a ritonavir-boosted protease inhibitor to a dolutegravir-based regimen for maintenance of HIV viral suppression in patients with high cardiovascular risk: AIDS. 2017;31(18):2503–14.

Negredo E, Estrada V, Domingo P, Gutierrez MDM, Mateo GM, Puig J, et al. Switching from a ritonavir-boosted PI to dolutegravir as an alternative strategy in virologically suppressed HIV-infected individuals. J Antimicrob Chemother. 2017;72(3):844–9.

Aboud M, Kaplan R, Lombaard J, Zhang F, Hidalgo JA, Mamedova E, et al. Dolutegravir versus ritonavir-boosted lopinavir both with dual nucleoside reverse transcriptase inhibitor therapy in adults with HIV-1 infection in whom first-line therapy has failed (DAWNING): an open-label, non-inferiority, phase 3b trial. Lancet Infect Dis. 2019;19(3):253–64.

Taramasso L, Tatarelli P, Ricci E, Madeddu G, Menzaghi B, Squillace N, et al. Improvement of lipid profile after switching from efavirenz or ritonavir-boosted protease inhibitors to rilpivirine or once-daily integrase inhibitors: Results from a large observational cohort study (SCOLTA). BMC Infect Dis [Internet]. 2018;18(1). Disponible en: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050717684&doi=10.1186%2fs12879-018-3268-5&partnerID=40&md5=e02cb552150d086608625b3c61119e0b

Arribas JR, Pialoux G, Gathe J, Di Perri G, Reynes J, Tebas P, et al. Simplification to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus continuation of ritonavir-boosted protease inhibitor with emtricitabine and tenofovir in adults with virologically suppressed HIV (STRATEGY-PI): 48 week results of a randomised, open-label, phase 3b, non-inferiority trial. The Lancet infectious diseases. 2014;14(7):581–9.

Hodder S, Squires K, Kityo C, Hagins D, Avihingsanon A, Kido A, et al. Efficacy and safety of switching to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (E/C/F/Taf) in virologically suppressed women. Journal of acquired immune deficiency syndromes. 2018;78(2):209.

Pozniak A, Markowitz M, Mills A, Stellbrink H-J, Antela A, Domingo P, et al. Switching to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus continuation of non-nucleoside reverse transcriptase inhibitor with emtricitabine and tenofovir in virologically suppressed adults with HIV (STRATEGY-NNRTI): 48 week results of a randomised, open-label, phase 3b non-inferiority trial. The Lancet Infectious Diseases. 2014;14(7):590–9.

Daar ES, DeJesus E, Ruane P, Crofoot G, Oguchi G, Creticos C, et al. Efficacy and safety of switching to fixed-dose bictegravir, emtricitabine, and tenofovir alafenamide from boosted protease inhibitor-based regimens in virologically suppressed adults with HIV-1: 48 week results of a randomised, open-label, multicentre, phase 3, non-inferiority trial. Lancet HIV. 2018;5(7):e347–56.

Quercia R, Roberts J, Martin-Carpenter L, Zala C. Comparative Changes of Lipid Levels in Treatment-Naive, HIV-1-Infected Adults Treated with Dolutegravir vs. Efavirenz, Raltegravir, and Ritonavir-Boosted Darunavir-Based Regimens Over 48 Weeks. Clin Drug Investig. 2015;35(3):211–9.

Van Lunzen J, Maggiolo F, Arribas JR, Rakhmanova A, Yeni P, Young B, et al. Once daily dolutegravir (S/GSK1349572) in combination therapy in antiretroviral-naive adults with HIV: Planned interim 48 week results from SPRING-1, a dose-ranging, randomised, phase 2b trial. Lancet Infect Dis. 2012;12(2):111–8.

Raffi F, Jaeger H, Quiros-Roldan E, Albrecht H, Belonosova E, Gatell JM, et al. Once-daily dolutegravir versus twice-daily raltegravir in antiretroviral-naive adults with HIV-1 infection (SPRING-2 study): 96 week results from a randomised, double-blind, non-inferiority trial. The Lancet infectious diseases. 2013;13(11):927–35.

Raffi F, Rachlis A, Stellbrink H-J, Hardy WD, Torti C, Orkin C, et al. Once-daily dolutegravir versus raltegravir in antiretroviral-naive adults with HIV-1 infection: 48 week results from the randomised, double-blind, non-inferiority SPRING-2 study. The Lancet. 2013;381(9868):735–43.

Walmsley SL, Antela A, Clumeck N, Duiculescu D, Eberhard A, Gutierrez F, et al. Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369(19):1807–18.

Clotet B, Feinberg J, Van Lunzen J, Khuong-Josses M-A, Antinori A, Dumitru I, et al. Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study. The Lancet. 2014;383(9936):2222–31.

Descargas

Publicado

06-07-2021

Cómo citar

Lopera-Rodríguez, J. A., & López-Quiceno, L. (2021). Perfil lipídico e inhibidores de integrasa: revisión sistemática y metaanálisis. CES Medicina, 35(2), 77–97. https://doi.org/10.21615/cesmedicina.6017

Número

Sección

Artículos de revisión
Estadísticas de artículo
Vistas de resúmenes
Vistas de PDF
Descargas de PDF
Vistas de HTML
Otras vistas

Algunos artículos similares: