Efectos inmunológicos de los inhibidores de integrasa como parte de la terapia de inicio en personas viviendo con VIH: revisión sistemática de la literatura
DOI:
https://doi.org/10.17533/udea.iatreia.255Palabras clave:
Inhibidores de Integrasa VIH, Terapia Antirretroviral Altamente Activa, Reconstitución Inmune, revisión sistemáticaResumen
Introducción: el uso de fármacos inhibidores de integrasa dentro de la terapia antirretroviral altamente activa (TARAA) ha mostrado beneficios en personas viviendo con el VIH. Sin embargo, la mayoría de las comparaciones se basan en la efectividad sobre la replicación viral, pero existe información limitada acerca de su efecto sobre el sistema inmune.
Objetivo: identificar los desenlaces inmunológicos en estudios que comparan inhibidores de integrasa con otros medicamentos utilizados como tercer fármaco en la TARAA.
Métodos: revisión sistemática de estudios que reportaban pacientes tratados con inhibidores de integrasa (INSTI) vs. inhibidores de transcriptasa reversa no análogos de nucleósido (ITRNN) o inhibidores de proteasa (IP) como tercer fármaco de la TARAA. Se evaluaron desenlaces de reconstitución inmunológica incluyendo recuento de linfocitos T CD4+; índice CD4/ CD8; concentración sérica de sCD14, dímero D y proteína C reactiva; frecuencia y fenotipo de las células T; capacidad funcional de las células T y ADN proviral.
Resultados: en total fueron tamizados 2804 estudios, se evaluaron 59 en texto completo y cuatro fueron incluidos en la síntesis. Una investigación de cohorte reportó normalización del índice CD4/CD8 en pacientes que iniciaron con INSTI vs. IP o ITRNN. Sin embargo, este hallazgo no fue replicado en los demás estudios, e incluso, en uno de ellos este índice fue mayor en quienes recibieron efavirenz vs. dolutegravir. No se encontró evidencia para los demás desenlaces.
Conclusiones: los estudios analizados no son concluyentes sobre las diferencias en la reconstitución inmunológica de los INSTI vs. los IP y los ITRNN.
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