..Drafting.
Despite the fact that there is still no definitive cure for patients infected with the human immunodeficiency virus (HIV), advances in treatment with antiretroviral drugs have achieved that, in addition to having a much better prognosis, they can enjoy better quality of life. The Dr. Eugenia Negredohead of HIV at the Infectious Diseases Service at the Germans Trias i Pujol University Hospital explains in an interview organized by iSanidad in collaboration with Gilead that, once a highly efficient treatment has been achieved, work is now being done to improve the form of administration, above all, to make it more comfortable for patients.
Has the coronavirus crisis really impacted patient treatment?
Clearly yes. During the first and second waves there was a bit of lack of control of all the chronic patients. Any chronic patient, who followed regular visits, during the first waves suffered cancellation of visits, delays, changes… the patients were lost and the health workers too. In the case of patients with HIV, who cannot go to pick up their medication at the pharmacy, but rather receive their medication at the hospital, strategies had to be found, such as, for example, sending it home by courier so that they could follow the treatment correctly. In other words, there were indeed difficulties, although all possible means were put in place so that they did not have to interrupt the treatments.
There are many patients for whom taking medication every day affects them emotionally, because it reminds them that they are sick
The general saturation of primary care, is it a problem for patients
In the specific case of HIV patients, follow-up usually takes a long time in the hospital. We are practically your wax doctor, although it is true that, as patients get older, they present new problems, typical of age. For the management of these diseases, we do support each other a lot and coordinate with primary care. In this sense, the saturation of primary care does make patients come back or call the hospital more frequently when they cannot contact or have pending issues.
What are advances in antiretroviral treatments contributing in terms of quality of life, long-term global health, etc.?
The antiretroviral treatment we currently have is excellent at curbing the virus. They are very effective drugs, very safe and with little toxicity. If the patient takes it well, the virus can no longer be detected in the blood and even that person stops transmitting the virus, even with sexual intercourse without a condom. The control part of the virus, so to speak, is achieved. However, it is expected that new products will come onto the market to improve the frequency and mode of administration of these drugs. At the moment, patients have to take tablets daily and, with these new formulas, it could be spaced much further apart in time.
There are many patients for whom taking medication every day affects them emotionally, because it reminds them that they are sick or because, for example, they do not want to have the medication at home and other people see it. Let’s not forget that having HIV still carries a great social stigma. Other patients don’t mind taking their pills daily. Therein lies the grace, in being able to have different options so that the patient can choose the one that best suits their needs and situation.
The saturation of primary care causes patients to go to the hospital more frequently when they cannot be contacted or have pending issues
Can HIV be eradicated? What do patients and professionals need to advance in its disappearance?
HIV is going to be eradicated, I have no doubt about this. What happens is that it is costing and it will still take a while, because the virus hides inside the cells. In the human body some cells are active and others remain “asleep”. HIV is able to hide in resting cells and, when these cells are activated, the virus returns to the blood. HIV hides in so-called sanctuaries or reservoirs, which are places where it is difficult for treatment to reach, for example, the lymph nodes.
This means that, although we no longer have viruses in our blood, because the treatment eliminates them, the virus continues to hide in the sanctuaries or reservoirs. There is a lot of research in this regard, with different strategies, from waking up that virus that is asleep and then attacking it all at once, to leaving it in there and making it unable to leave these cells that are asleep.
Is adherence to treatment one of the main problems of patients?
I would say not. At least in the environment that I know of, adherence to treatment is good in a very high percentage of patients. Patients have made taking a pill daily a part of their lives, and although it may be a hassle, they do. There is a small percentage of patients who may abandon treatment because they are going through a bad time, due to psychiatric disorders, economic problems, a city transfer or other problems that cause them to suddenly abandon it. And time later they return to the units to take it up again.
This is a problem, but it is not as serious as the cases in which patients take their medication poorly: today they take it, tomorrow they don’t, one day they forget and then the next they take twice as much, they don’t take it on the weekend, etc. . This lack of control can cause the virus to become resistant, because they are half taking the medication. The same thing happens with antibiotics, that when you take them wrong, you can develop resistance to the antibiotic. The same thing happens with these treatments.
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