A study associated with damage to the central nervous system, using Kaletra ® monotherapy in patients with undetectable viral load
A small study whose results were published in 14 the January issue of the journalThe Journal of AIDS found elevations of certain markers of immune activation in the spinal fluid of people with HIV who were taking lopinavirritonavir alone (Kaletra ®). These elevations, observed even in people with undetectable viral load, may be signs of possible damage to the central nervous system, which could result in cognitive neuro disability.
While the use of effective anti-retroviral regimens has enabled greatly increased life expectancy and reduced the incidence of dementia in persons with HIV, the central nervous system can suffer damages as a result of constant immune activation, viral or escape due to the drug toxicity.
As a result, now that new treatment options are available, and that many patients who have lived a long time with HIV and are aging, it is crucial to consider the potential side effects on the central nervous system when choosing treatment guidelines.
Simplification of antiretroviral therapy (HAART) is a strategy that is researched and sometimes takes practice, for many reasons, such as increasing the comfort of treatment (???), reducing the number of tablets, and reducing the Toxicity andreduce costs. Among the simplification strategies, the most common is switching to monotherapy with a protease inhibitor boosted by ritonavir (Norvir ®) after reaching undetectable level with a standard antiretroviral regimen (HAART).
Kaletra ® is one of protease inhibitors, along with Prezista ® (darunavir) boosted by ritonavir (Norvir ®) has been most widely used as monotherapy. His power and the high genetic barrier to resistance development make it an attractive option for use as monotherapy. However, according to the new findings of this review, the use of unconventional treatment guidelines - as monotherapias - may be sometimes less effective than a standard three drugs in reduced immune activation and inflammation of the nervous system central.
The acronym more- study for monotherapy in Switzerland and Thailand - was a controlled study and open, with the drug distributed randomly to participants from different hospitals with undetectable viral load for more than six months and tested without any failure in two groups: one patients continued their treatment (continuation of treatment arm) and the other began taking lopinavirr (monotherapy arm) alone. The results for the study would be expected to maintain such groups per 48 weeks, and subsequently the two groups would then be used for monotherapy for more than 48 weeks. However, the study could not be completed, since there was a complication that generated a disturbance of the criteria set by the assay protocol: virological failure of the first six 30 (20) monotherapy patients, patients with a CD4 count below the 200 mm3 cells (see the day's news 26 / 02 / 2009).
On this occasion, the researchers evaluated spinal fluid samples from 34 participants of continued therapy arm; 31 of patients in the monotherapy arm and 29 seronegative controls with Alzheimer's disease in order to respect the levels of inflammation and immune activation markers as S100B (whose elevation indicates an astrocyte proliferation, glial cells that protect and support neurons) , neopterin (a marker of inflammation) and activation of macrophages and neuronal damage.
The analysis found that S100B levels were significantly higher in patients than in the monotherapy group at the continuation of therapy arm participants or persons with Alzheimer's disease in the control group, irrespective of whether or not the viral load is undetectable in plasma or cerebrospinal fluid. Neopterin Levels alone, however, was significantly higher than in the other two groups group only when included in the analysis of patients with detectable HIV viral load in plasma and cerebrospinal fluid.
In 16 patients with HIV who formed a parallel control group - HIV levels in patients taking the triple therapy and another level when they were medicated lopinavirritonavir monotherapy S100B and neopterin, the levels were significantly higher in samples taken during treatment monotherapy.
Although the findings of this small study should be confirmed in larger clinical trials, the results are particularly disappointing in relation to the use of monotherapy with protease inhibitors boosted by ritonavir - at least lopinavirritonavir - because, in addition to virological failures documented with these treatment strategies in different tests, there are signs constant central nervous system damage, when used in the present antiretroviral nonstandard orientation.
Whereas lopinavirritonavir is considered one of antiretroviral drugs with better penetration into the cerebrospinal fluid, the findings of this study will put into question the effectiveness of Kaletra ® to prevent and avoid the deterioration in the central nervous system, when used as monotherapy.
Note the Seropositive Editor Web Site: The population is aging with HIV and, so far, with "a certain quality of life." I myself am coming there to 51 years and if I used beards, already would have put my sauce. In my case the primary HIV infection was meningitis and notice, years later I had another meningitis ... I'm not given up hope of games and I am very objective when the thing comes to me. In addition to these two events, I suffer with a peripheral neuropathy, which makes me take well pesadinhas drugs such as gabapentin and Methadone, only to "mitigate" the pain.
I admit that, in most cases this works; today, however, do not feel my left hand, which is dormant. This is called paresthesia and is an unpleasant symptom, but much more friendly that my crisis soreness, which usually end up in the emergency room of St. Camillus, because it hurts the bessa nor injectable morphine has done more than relieve a couple of hours. So when the crisis is hyperesthesia I hope dent in my bed it to pass.
It is clear to me that my HIV infection operates extensively in my central nervous system and only God can avoid this.
Anyway, I'll live the way I told people live, when I volunteered in the CRTA. One day at a time ... But there are some who wtf
Another very important thing is that it seems to me there research in order to _reduzir custos_ treatments and that these trials, although I believe that they follow ethical standards not objectionable by the scientific community, I, who am not part of that community, or none of the axes that connect these surveys to governments or _) empresas_ Pharmaceutical Industry (please do not distort my thought giving the capitalization as a show of respect) throw doubt on the correctness and even morality to change the treatment of a person, that was having good results for a method (monotherapy) in the decade of 1980 and part of 1990, decimated millions of lives! OR is that, being a half-dozen souls watching this all right and come on. And finally, I take 22 pills a day, do not feel bothered by them and, if so reduce my treatment I will feel even abandoned by my infectious ... And again: WTF