La vacuna es el tratamiento

 

 

Aumentar el número de diagnósticos y de personas en tratamiento es el nuevo paradigma de prevención de la  del  que  propone basado en los resultados de un estudio realizado en Estados Unidos.

AIDS Healthcare Foundation (AHF) en México ha propuesto replantear todo el sistema de salud referente al diagnóstico y atención de las personas que viven con VIH, tomando como base el estudio HPTN 052 que fue financiado por los Institutos Nacionales de Salud ( por sus siglas en inglés) de Estados Unidos y duró más de cinco años.

Este estudio, presentado a principios de mes por AHF en el Hotel Four Seasons del D.F, fue realizado a 1700 parejas serodiscordantes (cuando uno de los miembros vive con VIH y el otro no) y demostró que si las personas que viven con VIH reciben el tratamiento antirretroviral y logran el control de su , disminuyen el riesgo de transmitirlo hasta en un 96%.

La nueva estrategia tiene implicaciones económicas. La doctora Patricia Campos, directora de la Oficina de AHF para Latinoamérica, señaló la importancia de la negociación con las farmacéuticas “para que el tratamiento de primera línea (inicial) tenga un precio razonable de 500 dólares en vez de los 2000 dólares actuales”. Además, compartió el dato de que “la atención en el primer año de tratamiento con la enfermedad avanzada cuesta cinco veces más que la atención oportuna.”

Por otra parte, el ensayo clínico controlado START mencionado por el doctor Juan Sierra, reconocido infectólogo especialista en VIH, demostró una mayor eficacia (calidad de vida) cuando el tratamiento comienza con un  arriba de 500 (como lo propone AHF), que con lo recomendado actualmente por las guías de la que indican que se comience el tratamiento con  de 350 o menor.

La Dra. Campos compartió los avances en el diagnóstico a través de pruebas rápidas que AHF lleva realizados en los cuatro años de presencia en México: 163.000 pruebas rápidas de las cuales 2786 resultaron positivas, lo que representaría casi el 7% de las nuevas infecciones que se presentaron en México en el mismo periodo. La estrategia “” (Pruébate y Trátate) lleva dos años en México, ya que AHF está convencida que es la mejor estrategia para lograr el control de la epidemia. Señaló también que cuando una persona obtiene dos resultados positivos se la refiere, y en muchos casos se le acompaña, a la unidad médica de atención especializada más cercana con el fin de que inicien tratamiento.

En nuestro país en 2010 había 225.000 personas con VIH, de las cuales el 29% recibían tratamiento antirretroviral, 14% no requerían ARV de acuerdo con las guías internacionales, y el 57% no conocían su estado serológico. Esto significa que 160.000 mexicanos que viven con VIH podrían transmitir el virus.

Por su parte, el Dr. Jorge Saavedra, Embajador para Asuntos Internacionales de AHF, señaló que “cuando el tratamiento de VIH logra controlar la carga viral se transforma en una especie de vacuna y provoca una prevención positiva, ya que el tratamiento sólo se les da a quienes resultan positivos al VIH.” También indicó que “se han elaborado modelos matemáticos en los que se muestra que si se lograra que el 100% de las personas con VIH se incorporasen al tratamiento, se obtendría como resultado que la epidemia mundial del  se detendría.”

Como lo señaló el Dr. Juan Sierra, el tratamiento antirretroviral salva vidas, mantiene a la persona social y económicamente productiva, y previene nuevas infecciones. Iniciar el tratamiento antes es beneficioso para las personas que han adquirido el VIH y para sus parejas sexuales.

Sin embargo es importante puntualizar que aún no hay evidencias científicas suficientes para afirmar que las personas que viven con VIH y se encuentran en tratamiento antirretroviral no transmitirían el virus en una relación sexual sin protección. No existen garantías de que las personas en tratamiento sean siempre adherentes a éste de forma de mantener el virus suprimido para limitar la transmisión. El resultado de una carga viral es una “fotografía” de la cantidad de virus en el suero de la sangre en el momento en que se extrajo la muestra de sangre, situación que podría variar en los días y semanas posteriores.

Por ello, aún cuando es cierto que saturar determinadas comunidades con tratamiento antirretroviral eficaz podría reducir la tasa de transmisión, la única estrategia internacionalmente consensuada es la promoción y uso adecuado del condón. Algunos especialistas consideran prematuro y potencialmente irresponsable recomendar a parejas serodiscordantes mantener relaciones sexuales sin protección aún cuando la persona con VIH hubiera reducido su carga viral a niveles indetectables.

Finalmente, la variable costo no debe ser subestimada porque nuestros países –con financiamiento externo o doméstico- tienen serias limitaciones para cubrir el tratamiento antirretroviral de las personas con VIH con menos de 350 de CD4.


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