Antiretroviral treatment has made HIV a chronic disease

In Mexico, 301,182 people with HIV infection are in the epidemiological surveillance registry of the National Center for the Prevention of HIV and AIDS (CENSIDA), of which 36% have died and 5% their current status is unknown. For these patients, antiretroviral treatment has modified the course of infection by VIH until it becomes a chronic disease, reducing the viral load of a person to undetectable levels, which means not only an improvement in the quality of life, but also reduces the risk of transmitting HIV, which is why the need is relevant to have effective drugs.

In cancer medicine there have been several advances and milestones for antiretroviral therapy. From the 80s to the mid-90s there was nothing to offer patients and the management was palliative, from 95 to 2005 the first treatments began to be given “, explains Marco Isaac Banda Lara, internist, infectologist and affairs manager HIV doctors at GSK Mexico.

He shares that the options began to combine, they were drugs from different families that allowed people to begin to survive AIDS, but still at the expense of great toxicity and long-term side effects.

From 2005 to 2015, therapies improved and many of these drugs were reduced in the number of tablets, which favored adherence, tolerability and the amount of viruses they suppressed or eliminated from the blood, since the drugs do not cure the disease until now. Rather, they “keep the virus absent in the blood and hidden in the lymph nodes”, in this way it was achieved that the patient has a life expectancy very similar to the one he had before acquiring the infection.

But in recent years a new family of drugs has appeared called second-generation integrase inhibitors, which in fact are already included in the antiretroviral treatment guideline. These drugs, in addition to achieving a great suppression of the virus, because they lower the concentration of these in the blood very quickly, they quickly recover the defense cells of the patients, there is also good tolerability, it is difficult for the virus to make resistance mutations to these Medications and these in combination with others have achieved that there is no toxicity and preserve your organs in the long term.

Banda Lara explains that antiretroviral therapies from the 1990s are available in Mexico through the federal government and health institutions, and little by little innovation therapies are being included in the basic charts. Even recently the Federal Commission for the Protection against Sanitary Risks (Cofepris) gave the authorization for the use of the first treatment of two drugs in a single tablet, this indicated for adults and adolescents over 12 years of age who weigh at least 40 kilos.

It is the combination of dolutegravir, which inhibits the replication of VIH by preventing viral DNA from integrating into the genetic material of human immune cells (T cells); with lamivudine that interferes with the conversion of viral ribonucleic acid (RNA) to deoxyribonucleic acid (DNA), which in turn stops the virus from multiplying.

It is expected that very soon this treatment will be evaluated by the Health Council so that it can later be included in public institutions. “It is important to have different options so that if the doctor faces patients, for example with drug interactions, that is, when patients have some other disease that is not carried out with all antiretrovirals, he can offer cutting-edge therapies and not have to sacrifice efficacy, safety or toxicity using other types of therapies ”.

The specialist concludes that if something has taught us the Covid-19 pandemic, is that there is a lot of inequality, “we see this for example with vaccines, but it impacts in all areas, for HIV it is the same”, that is why this year’s motto is precisely to put an end to inequality, AIDS and pandemics. “In HIV, they have been dealing with this pandemic for almost 40 years and it is something that we have not been able to close, there is a lack of more diagnosis, less stigma and that more people are linked to treatment so that there are fewer cases of AIDS until this problem is put to an end.”

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