Un estudi realitzat amb prop de 2.300 pacients de VIH severament immunodeprimits i liderat per investigadors de l\u2019Hospital Universitari de Bellvitge i l\u2019IDIBELL conclou que fins i tot en els pitjor dels escenaris en qu\u00e8 es comenci el tractament si es recupera la resposta immunpl\u00f2gica i baixa la c\u00e0rrega viral o nom\u00e9s una de els dues coses, el pacient es capa\u00e7 de controlar la malaltia Les autoritats sanit\u00e0ries recomanen des de fa un temps que els pacients infectats per VIH comencin el tractament just despr\u00e9s del diagn\u00f2stic, independentment dels nivells d\u2019immunosupressi\u00f3 (que es mesuren pel n\u00famero de CD4 en sang, les c\u00e8l\u00b7lules responsables de la resposta immunol\u00f2gica i que s\u00f3n infectades pel virus) i de les c\u00f2pies del virus que es detectin (c\u00e0rrega viral). <\/p>\n
\u201cEl problema \u00e9s la realitat que ens trobem a la cl\u00ednica\u201d explica el Dr Daniel Podzamczer, cap de la Unitat de VIH i ETS del Servei de Malalties Infeccioses de l\u2019Hospital Universitari de Bellvitge (HUB) i investigador del grup d\u2019infeccions respirat\u00f2ries i en l\u2019hoste immunocomprom\u00e8s de l\u2019Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge (IDIBELL). \u201cEls pacients arriben moltes vegades severament immunodeprimits i amb aquest estudi hem volgut observar l\u2019evoluci\u00f3 dels pacients que arriben tard al tractament, que en el nostre cas s\u00f3n aproximadament un 22% amb CD4 < 200 c\u00e8l\u00b7lules per mm3\u201d. \n\n L\u2019estudi, publicat al Journal of Antimicrobial Chemotherapy, s\u2019ha realitzat amb pacients de la cohort PISCIS (amb la col\u00b7laboraci\u00f3 d\u2019altres hospitals i del CEEISCAT) que inclou m\u00e9s de 17.000 pacients infectats amb VIH de diversos hospitals de Catalunya i les Illes Balears. S\u2019ha fet el seguiment durant cinc anys de 2.300 pacients que quan van comen\u00e7ar el tractament presentaven nivells de CD4 molt baixos, menors de 200 c\u00e8l\u00b7lules per mm3. \n\n El que han observat \u00e9s que el 78% dels pacients que no responen al tractament ni amb un augment dels CD4 ni amb una baixada de la c\u00e0rrega viral, progressen a SIDA o moren. En canvi, si no recuperen la resposta immunol\u00f2gica per\u00f2 la c\u00e0rrega viral \u00e9s indetectable, la mortalitat i la progressi\u00f3 a SIDA baixen gaireb\u00e9 a la meitat, 35%. Si no s\u2019assoleix una c\u00e0rrega viral indetectable per\u00f2 els CD4 pugen per sobre de 200, la progressi\u00f3 de la malaltia baixa a 18%. \u00c9s a dir, que la recuperaci\u00f3 immunol\u00f2gica \u00e9s m\u00e9s important per\u00f2 la resposta virol\u00f2gica tamb\u00e9 juga un paper clau. \n\n \u201cSi, a m\u00e9s a m\u00e9s, el pacient que ha comen\u00e7at el tractament en aquestes condicions tan desfavorables aconsegueix recuperar els nivells immunol\u00f2gics per sobre de 200 c\u00e8l\u00b7lules per mm3 i una c\u00e0rrega viral indetectable, la progressi\u00f3 de la malaltia a SIDA o mort als 5 anys de seguiment \u00e9s de tant sols un 2%, afirma la Dra. Elena Ferrer, primera autora de l\u2019estudi, metgessa de la Unitat de VIH i ETS, investigadora del grup d\u2019infeccions respirat\u00f2ries i en l\u2019hoste immunocomprom\u00e8s de l\u2019IDIBELL i metge del servei de malalties infeccioses del HUB. \n\n I, finalment, segons el Dr. Podzamczer \u201ctot i que, fins i tot en els pitjor dels casos, es pot lluitar contra l\u2019evoluci\u00f3 de la malaltia, no hem d\u2019oblidar que un 30% d\u2019aquests pacients\n\n no van aconseguir recuperar la resposta immunol\u00f2gica. I la recomanaci\u00f3 continua sent diagnosticar i tractar al pacient el m\u00e9s aviat possible, i per aix\u00f2 \u00e9s necess\u00e0ria una tasca de prevenci\u00f3 i d’informaci\u00f3 a la societat\u201d. \n\n Ferrer E*, Curto J, Esteve A, Miro JM, Tural C, Murillas J, Segura F, Barrufet P, Casabona J, Podzamczer D. Clinical Progression of severaly immosuppressed HIV-infected patients depends on virological and immunological imrpovement irrespective of baseline status. J Antimicrob Chemother. 2015 Sep 25. pii: dkv272. [Epub ahead of print]\n<\/p>\n","protected":false},"excerpt":{"rendered":"
Fins ara nom\u00e9s es tenia en compte la situaci\u00f3 basal del pacients L\u2019estudi conclou que tot i que en el pitjor dels escenaris els pacients poden arribar a controlar el virus, el tractament s\u2019ha d\u2019iniciar des del moment del diagn\u00f2stic M\u00e9s de la meitat dels pacients arriben tard al tractament Refer\u00e8ncia de l\u2019article<\/p>\n","protected":false},"author":6,"featured_media":10839,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[1,391],"tags":[],"publishpress_future_action":{"enabled":false,"date":"2024-05-12 05:39:55","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"_links":{"self":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/8057"}],"collection":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/comments?post=8057"}],"version-history":[{"count":0,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/8057\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media\/10839"}],"wp:attachment":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media?parent=8057"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/categories?post=8057"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/tags?post=8057"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}