Eficacia, efectividad y seguridad de los inhibidores de la integrasa en el tratamiento del VIH/SIDA en pacientes con tuberculosis: revisión sistemática y metanálisis
DOI:
https://doi.org/10.33448/rsd-v11i10.32636Palabras clave:
VIH; SIDA; Tuberculosis; Inhibidores de la integrasa; Revisión sistemática.Resumen
Los inhibidores de la integrasa son una clase prometedora de antirretrovirales. Sin embargo, los estudios de estos farmacos en la coinfección de tuberculosis (TB) y VIH/SIDA son escasos. Por lo tanto, el objetivo de esta revisión fue evaluar la eficacia, la efectividad y la seguridad de los inhibidores de la integrasa en la coinfección. Se realizaron búsquedas en las bases de datos MEDLINE, EMBASE, LILACS, COCHRANE, Web of Science, Scopus y CINAHL, utilizando los términos HIV, AIDS, Tuberculosis, Raltegravir Potassium, dolutegravir, elvitegravir, bictegravir, Integrase Inhibitor y sus respectivos sinónimos. Se incluyeron informes referentes a tres ensayos clínicos aleatorizados y una cohorte histórica. Los pacientes coinfectados con TB y VIH/SIDA mostraron una buena respuesta al tratamiento de la TB, superior al 85% en todos los brazos de los estudios evaluados. Como criterio principal de valoración, las tasas de supresión de la carga viral del VIH en la semana 48 fueron superiores al 60 % en todos los brazos. Las terapias evaluadas en pacientes coinfectados con TB y VIH/SIDA también han demostrado ser seguras. Sin embargo, no hubo diferencia significativa en los resultados de eficacia entre los brazos de efavirenz versus inhibidor de la integrasa y para los resultados de seguridad se observaron pocos eventos en relación con el total. Los inhibidores de la integrasa en pacientes coinfectados con TB y VIH/SIDA parecen ser efectivos, bien tolerados y constituir una alternativa a efavirenz en los protocolos clínicos. Sin embargo, el uso de este fármaco dos veces al día compromete la adherencia al tratamiento. El papel de estos fármacos debe determinarse mejor mediante estudios adicionales de buena calidad metodológica para evaluar su eficacia, efectividad y seguridad a largo plazo.
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Derechos de autor 2022 Natália Helena de Resende; Laís Lessa Neiva Pantuzza; Wânia da Silva Carvalho; Silvana Spíndola de Miranda; Isabella Zuppo Laper; Adriano Max Moreira Reis
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