ABSTRACT
INTRODUCTION: Second-generation integrase strand transfer inhibitors such as bictegravir (BIC) and dolutegravir (DTG) are the standard of care for starting therapy in people living with HIV (PLHIV). However, their use has been associated with neuropsychiatric symptoms (NPSs) that may lead to treatment discontinuation. We aim to describe and synthesize information on safety and discontinuation rates and to summarize potential risk factors associated with the development of NPSs in PLHIV treated with these regimens. AREAS COVERED: A systematic review of the literature was carried out in the international databases PubMed/Medline, Web of Science (WoS), Scopus, Embase, and Cochrane Library from 2013 to June 2022. Ninety observational studies reporting data on treatment discontinuation due to drug-related adverse events and NPSs were identified. EXPERT OPINION: Discontinuation rates due to NPSs increase with treatment time and, in light of the reviewed studies, are higher in PLHIV treated with DTG-based regimens compared with those treated with BIC/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF). This information could be useful for clinicians during treatment decision-making, reducing discontinuation rates and thereby promoting treatment success and durability. Additionally, the identification of potential risk factors in PLHIV prior to starting therapy could also help make the best therapy choices based on the characteristics of each individual.
Subject(s)
Anti-HIV Agents , HIV Infections , HIV Integrase Inhibitors , Humans , HIV Infections/drug therapy , Integrase Inhibitors/therapeutic use , Emtricitabine/therapeutic use , Treatment Outcome , Drug Combinations , Heterocyclic Compounds, 3-Ring , Amides/therapeutic use , HIV Integrase Inhibitors/therapeutic useABSTRACT
Desde hace siglos sabemos que muchas características de los seres vivos se heredan. En los últimos años se ha avanzado mucho en el conocimiento de muchas enfermedades mendelianas causadas por mutaciones en uno o en un reducido número de genes. Sin embargo, el conocimiento de las bases genéticas de las enfermedades complejas, entre ellas la cardiopatía isquémica, está siendo mucho más dificultoso. En esta revisión de carácter narrativo, tenemos como objetivo revisar algunos de los resultados más relevantes obtenidos hasta la fecha sobre el estudio del componente genético de la cardiopatía isquémica. Presentamos los resultados más importantes que han aportado los estudios de ligamiento y asociación, incluidos los estudios de asociación integral del genoma. Por último, revisamos la utilidad que estos resultados pueden tener en la práctica clínica diaria y la prevención, y los retos previsibles para el futuro inmediato (AU)
It has been known for centuries that many of the characteristics of living creatures are inherited. In recent years, considerable progress has been made in our understanding of many mendelian diseases caused by mutations in one or a small number of genes. However, it is proving much more difficult to elucidate the genetic basis of complex diseases, including coronary heart disease (CHD). The objective of this paper was to review some of the most significant findings observed to date in studies into the genetic component of CHD. We report on the most important results from linkage and association studies, including genome-wide association studies. Finally, we summarize the potential usefulness of these findings for daily clinical practice and disease prevention, and look forward to the challenges we can expect to encounter in the near future (AU)
