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IMPACTO DE LA TERAPIA ANTIRRETROVIRAL DE GRAN ACTIVIDAD (TARGA) EN LA HISTORIA NATURAL DE NIÑOS INFECTADOS VERTICALMENTE POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA TIPO 1 (VIH-1)

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IMPACTO DE LA TERAPIA ANTIRRETROVIRAL DE GRAN ACTIVIDAD (TARGA) EN LA HISTORIA NATURAL DE NIÑOS INFECTADOS VERTICALMENTE POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA TIPO 1 (VIH-1)

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La utilización generalizada de TARGA ha permitido una mejora inmunológica y virológica que se ha visto reflejada en una mejora del estado clínico de los niños.
munosfer.jpg Autor:
María Angeles Muñoz-fernández
Columnista Experto de SIIC
Artículos publicados por María Angeles Muñoz-fernández
Coautores
Salvador Resino García*  José María Bellón Cano** 
Doctor en Ciencias Biológicas Laboratorio de Inmuno-Biología Molecular (Hospital General Universitario Gregorio Marañón).*
Diplomado en Estadística. Unidad de Investigación (Hospital General Universitario Gregorio Marañón).**
Recepción del artículo
27 de Febrero, 2004 		Primera edición
9 de Septiembre, 2004 		Segunda edición, ampliada y corregida
7 de Junio, 2021

IMPACTO DE LA TERAPIA ANTIRRETROVIRAL DE GRAN ACTIVIDAD (TARGA) EN LA HISTORIA NATURAL DE NIÑOS INFECTADOS VERTICALMENTE POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA TIPO 1 (VIH-1)

Resumen
Realizamos un estudio de marcadores clínicos y viroinmunológicos en niños infectados verticalmente por VIH-1 en tratamiento antirretroviral (TAR). Para determinar la incidencia de eventos clínicos, inmunológicos y virológicos utilizamos análisis de supervivencia. La respuesta inmunológica y virológica a la terapia antirretroviral de gran actividad (TARGA) fue más fuerte en niños sin TAR y con bajo número de cambios de drogas antirretrovirales anterior a la TARGA. Los valores de linfocitos T CD4+ y carga viral (CV) parecen jugar un papel importante para conseguir CV indetectable (CVi); sin embargo, la reducción de la CV sostenida en el tiempo es muy baja en los niños infectados por VIH. La CV basal es el mejor marcador pronóstico de fracaso virológico en niños VIH positivos. Por otro lado, los niños VIH en TAR durante el período calendario 1999-2001 tuvieron CV más bajas, valores de linfocitos T CD4+ más elevados y una supervivencia mayor que los niños con los TAR disponibles durante los períodos 1994-96 y 1997-98. A partir de 1997, el número de muertes desciende, pero el descenso drástico tiene lugar a partir del período calendario 1999-2001. Nuestros resultados son potencialmente de gran valor práctico en el seguimiento virológico del régimen antirretroviral utilizado y podrían servir como guía para el manejo clínico de niños infectados por VIH. La utilización generalizada de TARGA ha permitido una mejora inmunológica y virológica que se ha visto reflejada en una mejora del estado clínico de los niños.

Palabras clave
HIV-1, niños, terapia antirretroviral, TARGA, linfocitos T CD4+, carga viral, efectividad


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IMPACT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY PROTOCOLS ON NATUIRAL HYSTORY OF VERTICALLY HIV-1 INFECTED CHILDREN

Abstract
A study of clinical, virological and immunological markers in vertically HIV-1-infected children on antiretroviral therapy (ART) was performed. Survival analyses were used to determine the incidence of clinical, immunological and virlogical outcome. Immunological and virological responses to highly active antiretroviral therapy (HAART) were stronger in children who had not ART pre-HAART and ART-drug switches pre-HAART. CD4+ T-cells, and VL seem to play an important role for reach undetectable VL. Sustained viral reduction is very low in HIV-infected children. Moreover, basal VL is a useful prognostic marker for the virological failure in HIV-infected children. On the other hand, the children during the 1999-2001 period had longer survival than children during 1994-96 and 1997-98 periods. Children in the 1999-2001 period had the lowest VL, having and statistical differences with children in 1994-96 and 1997-98 period. A significantly large proportion of the children in 1999-2001 period had uVL. In 1994-96 and 1997-98 periods, there was a small percentage of uVL. During the 1999-2001 period, the children had the highest values of CD4+ T cells, and we found differences between the 1994-96 and 1997-98 periods and the 1999-2001 periods. The generalized use of HAART has permitted a better immunological, virological, and clinical status in HIV-infected children at the population level. Our results are potentially of great practical value in the virological follow-up of the therapeutical antiretroviral regimen used and could serve as a guide for the clinical management of HIV-infected children.

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Artículos originales > Expertos de Iberoamérica >
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Especialidades
Principal: Infectología, Inmunología, Pediatría
Relacionadas: Diagnóstico por Laboratorio, Farmacología, Infectología, Inmunología, Pediatría



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