Executive summary of the GESIDA/National AIDS Plan Consensus Document on Antiretroviral Therapy in Adults Infected by the Human Immunodeficiency Virus (Updated January 2016)

In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The objective of ART is to achieve an undetectable plasma viral load (PVL). Initial ART should comprise 3 drugs, namely, 2 nucleoside reverse transcriptase inhibitors (NRTI), and 1 drug from another family. Four of the recommended regimens, all of which have an integrase strand transfer inhibitor (INSTI) as the third drug, are considered a preferred regimen; a further 6 regimens, which are based on an INSTI, a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor boosted with cobicistat or ritonavir (PI/COBI, PI/r), are considered alternatives. The reasons and criteria for switching ART are presented both for patients with an undetectable PVL and for patients who experience virological failure, in which case the rescue regimen should include 3 (or at least 2) drugs that are fully active against HIV. The specific criteria for ART in special situations (acute infection, HIV-2 infection, pregnancy) and comorbid conditions (tuberculosis and other opportunistic infections, kidney disease, liver disease, and cancer) are updated.

ResumenSe recomienda tratamiento antirretroviral (TAR) a todos los pacientes con infección por VIH-1. El objetivo del TAR es lograr una carga viral plasmática (CVP) indetectable. El TAR inicial debe ser una combinación de 3 fármacos, que incluya 2 inhibidores de la transcriptasa inversa análogos de nucleósidos (ITIAN) y otro de distinta familia. Cuatro de las pautas recomendadas, todas las cuales tienen un inhibidor de la integrasa (INI) como tercer fármaco, se consideran preferentes, y otras 6, basadas en un INI, un inhibidor de la transcriptasa inversa no análogo de nucleósidos (ITINN) o un inhibidor de la proteasa potenciado con cobicistat o ritonavir (IP/COBI, IP/r), como alternativas. Se exponen las causas y los criterios para cambiar el TAR en los pacientes con CVP indetectable así como en los que presentan fracaso virológico, en cuyo caso el TAR de rescate debe incluir 3 (o al menos 2) fármacos plenamente activos frente al VIH. Se actualizan los criterios específicos del TAR en situaciones especiales (infección aguda, infección por VIH-2, embarazo) o comorbilidades (tuberculosis u otras enfermedades oportunistas, enfermedad renal, hepatopatías y neoplasias).