Un estudio en el que han participado más de 60 personas infectadas por el VIH ha permitido identificar seis genes implicados en la progresión rápida de la infección, gracias a los cuales es posible prever cómo evolucionará el virus en cada paciente.
El trabajo, publicado en el último número de la revista Journal of Clinical Investigation, revela que al menos 8 de cada 100 personas infectadas por el VIH responden a un modelo de progresión rápida; es decir, que la infección evoluciona muy rápidamente en su organismo y, en menos de tres años, su sistema inmunitario se ve muy deteriorado. El número inesperadamente elevado de pacientes con progresión rápida subraya la necesidad de reforzar el diagnóstico precoz para evitar casos fulminantes de SIDA y reforzar la prevención.
Los científicos apuntan que, dado que estos genes están relacionados con la activación del sistema inmunitario, la vacuna por el VIH se podría diseñar de tal forma que fuera capaz de manipularlos para estimular una respuesta inmunitaria adecuada. El estudio ha sido liderado por investigadores del Instituto de Investigación del Sida IrsiCaixa y el Departamento de Salud de la Generalitat de Catalunya, y ha contado, además, con la colaboración del Hospital Clínico de Barcelona y del Banc de Sang i Teixits, además de otras instituciones de ámbito internacional.
Según el investigador de IrsiCaixa responsable del estudio, Javier Martínez-Picado, que es asimismo profesor de investigación de ICREA, “la identificación de este grupo de genes ha sido posible gracias a que hemos conseguido reclutar la primera y más extensa cohorte de seguimiento de pacientes en los que la infección evoluciona de forma muy rápida, y hemos podido identificar además el porcentaje de estos tipos de pacientes, que es sorprendentemente elevado. Conocer estos genes resulta esencial para poder prever si el sistema inmunitario de los pacientes va a verse deteriorado rápidamente y recomendar así los tratamientos con mayores garantías de éxito”.
Hasta ahora, los casos de progresión rápida eran anecdóticos en la literatura científica, dada la complejidad para determinar la fecha de la infección y el breve período de tiempo disponible para identificar a estos pacientes, entre su diagnóstico y el inicio del tratamiento antirretroviral.
El estudio se ha llevado a cabo con una cohorte desarrollada conjuntamente con el Hospital Universitario de Lausanne, en Suiza, a partir del screening de miles de pacientes, de los cuales más de 100 habían desarrollado una progresión rápida de la infección. Para ser incluidos en la cohorte, era necesario que los pacientes reunieran dos condiciones básicas: que se hubieran sometido a la prueba del VIH previamente al contagio, para poder conocer la fecha aproximada en la que se infectaron –es decir, que entre la última prueba del VIH con resultado negativo y la detección de la infección hubiera transcurrido menos de un año– y que en menos de tres años presentaran un nivel de linfocitos T4 en sangre inferior a 350 por milímetro cúbico (que es el criterio médico para empezar a tratar la enfermedad).
A 66 de estos pacientes, la mitad de ellos de Barcelona y la otra mitad de Suiza, se les analizaron medio millón de posiciones de su ADN, así como de combinaciones de los genes conocidos como HLA que, en estudios anteriores, ya se habían asociado al ritmo de progresión de la infección por VIH. Los resultados confirmaron esta asociación en los pacientes con progresión rápida.
El proyecto HIVACAT de investigación y desarrollo de una vacuna contra el VIH está integrado por Los codirectores del proyecto HIVACAT son el Dr. Bonaventura Clotet, de IrsiCaixa, y el Dr. Josep Maria Gatell, del Hospital Clínic. Ambos centros desarrollan la investigación conjuntamente con más de cinco mil enfermos, quienes se benefician de la rápida incorporación de los nuevos tratamientos y de las innovaciones adquiridas en el ámbito internacional. HIVACAT cuenta con un equipo integrado por más de sesenta científicos formados en centros investigadores de prestigio internacional, como la Universidad de Harvard, el Instituto Pasteur de París o el Royal Free Hospital de Londres.
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