Información del artículo
En los últimos años se han producido grandes avances en la atención de los niños con infección por el virus de la inmunodeficiencia humana (VIH), sobre todo en el tratamiento antirretroviral, que se ha traducido en un aumento en la supervivencia y en la calidad de vida. El objetivo que se pretende con el tratamiento antirretroviral de gran actividad (TARGA), consistente en la combinación de al menos tres fármacos potentes, es la máxima y más duradera supresión de la replicación viral, lo cual no siempre es posible, a pesar de lo cual existe una mejoría inmunológica y clínica franca. Persisten grandes obstáculos para conseguir y mantener una máxima supresión de la replicación viral a largo plazo, entre los que se destacan la dificultad de adherencia permanente, con regímenes complejos y la posible toxicidad de la medicación. Los efectos adversos del tratamiento son frecuentes, siendo preocupante la elevada prevalencia de complicaciones metabólicas con unas consecuencias futuras desconocidas. Estas dificultades están motivando una tendencia actual para el inicio del tratamiento más conservadora, así como la implementación de estrategias con opciones terapéuticas simplificadas y con menor toxicidad. Es necesario continuar el desarrollo de fármacos que permitan vencer las todavía importantes limitaciones del tratamiento antirretroviral actual.
Palabras clave:
Infección por el VIH
Niños
Tratamiento antirretroviral
In recent years, major advances have been made in the care of HIV-infected children, particularly in antiretroviral treatment, which have dramatically improved survival and quality of life. The goal of highly active antiretroviral therapy (HAART), which includes at least three potent drugs, is the maximal and most durable suppression of viral replication possible, which is often not achieved despite clear immunologic and clinical improvement. There are still major barriers to achieving this goal, mainly the difficulty of permanent adherence to complex regimens and treatment-related toxicities. Adverse events are frequent, including a high prevalence of metabolic complications with unknown consequences in the future. These drawbacks of antiretroviral treatment are leading to a more conservative initial approach, as well as to research into simpler and less toxic therapeutic options. New strategies should continue to be developed to overcome the still important limitations of current antiretroviral treatment.
Key words:
HIV infection
Children
Antiretroviral treatment
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