Palabras clave
VIH-1
ART
resistencia a medicamentos
VIH/SIDA
NNRTI
INSTI
DRM
Categorías
Cómo citar
Resumen
El VIH/SIDA es una de las enfermedades infecciosas crónicas más importantes a nivel mundial en los últimos años. Aunque las terapias antirretrovirales (TAR) han reducido considerablemente la morbilidad y la mortalidad por VIH, existe un reporte continuo de nuevos casos. La resistencia a TAR contra el VIH-1 es uno de los problemas más importantes que retrasan los objetivos 95-95-95 establecidos por la Organización Mundial de la Salud, que como objetivo busca conseguir que los pacientes que viven con VIH (PVV) conozcan su diagnóstico, reciban tratamiento y eviten la transmisión del virus. La resistencia al TAR se da por la presencia de mutaciones en el genoma del VIH-1, tanto en pacientes que han recibido previamente tratamiento como aquellos que lo inician; constituyendo un factor de riesgo asociado al fracaso terapéutico y la transmisión de cepas resistentes al VIH-1. Se realizó un estudio observacional tipo transversal para determinar el perfil de resistencia a TAR que incluyó pacientes que recibieron o no previamente TAR en la unidad de VIH de un hospital en Quito, Ecuador, durante 2019 y 2021. Se recopilaron datos demográficos junto con muestras de sangre para secuenciación, genotipificación y determinación de mutaciones asociadas con la resistencia a TAR. En los 42 pacientes reclutados, la prevalencia mutaciones de resistencia a TAR (DRMs) para VIH-1 fue del 9.5%; siendo relacionadas con los fármacos inhibidores de la transcriptasa reversa no nucleosídicos (NNRTI). Se identificaron un total de 42 mutaciones: 38.6% relacionadas con los fármacos inhibidores de la proteasa (PIs), 34.09% con NNRTI/ inhibidores de la transcriptasa reversa nucleosídicos (NRTIs) y 22.7% con los fármacos inhibidores de la translocación de la integrasa (INSTIs), la mayoría de ellas consideradas menores o accesorias sin repercusión en la sensibilidad a TAR; ocasionando una potencial resistencia de bajo nivel (PLLR), resistencia de bajo nivel (LLR) y, en un paciente, alto nivel de resistencia (HLR) exclusivamente para los NNRTIs. Aunque se identificaron escasas mutaciones relacionadas con la resistencia a las diferentes combinaciones de TAR en el grupo de pacientes, se requieren estudios adicionales para caracterizar la resistencia a medicamentos del VIH-1 en Ecuador, su y sus implicaciones en la respuesta clínica.
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Derechos de autor 2025 Paulina Quirola Amores, Pablo Espinosa, Nelson Cevallos, Enrique Teran