2023-11-27 17:52:00
An increasingly protagonist territory also for people with HIV. “We are working on the idea that patients are not taken care of completely by the hospital. We must know how to stratify, that is, divide simple patients, to be followed in the area, from those with comorbidities due to aging, who will refer more to the centers. Healthcare is changing and decentralizing the treatment path is also important for the well-being of the patient who can be followed closer to home, thanks also to new therapies”. This was stated by Giuliano Rizzardini, director of the Department of Infectious Diseases Asst Fatebenefratelli Sacco, speaking today at the webinar entitled ‘Clinical-care management of people with HIV: what horizons?’, the third appointment of the cycle ‘Let’s talk about HIV today. To look to tomorrow’, promoted by time.news in collaboration with ViiV Healthcare and available on the channels web and social media of the publishing group.
Also participating in the live broadcast were Andrea Antinori, director of the Uoc Viral Immunodeficiencies of the National Institute for Infectious Diseases “Lazzaro Spallanzani” in Rome and Lorenzo Badia, infectious disease specialist at the Imola Local Health Authority’s infectious disease clinic. “The latest data from the Higher Institute of Health (ISS), Spallanzani and the Ministry of Health – explains Antinori – reveal that, compared to the ’95-95-95′ objective of the World Health Organization (WHO) to be achieved for 2025 – 95% of people diagnosed, 95% in access and treatment and 95% with virological suppression – Italy is at 94%. It means that 94 out of 100 people with HIV are virologically suppressed. The missing 6% is essentially due to people who have resistant viruses, for whom new drugs are needed, which are on the way. Another problem concerns the most fragile population among people with HIV, who are lost to follow up, and who must be re-engaged with structured programs that affect clinical and social aspects because they are the people most at risk of progressing with the disease”.
In the next 5-6 years “there will be two significant changes – states Badia – An older HIV population and more people on long-term drug therapy. The population with HIV will age, because the therapies – which today consist of just one tablet a day, ed. – have made this pathology chronic and, at the same time, there will be more people who will take new injectable formulations with a prolonged duration of action. There will be more work in the clinical center to administer these long-acting treatments. The territory will therefore have to be more involved in the aspect of aging which, in people with HIV, undergo the pathologies of aging earlier and more severely than the general population”.
As Rizzardini recalls, “when we make an early diagnosis and the person is followed by a center and antiretroviral therapy is certainly effective. Of course, it must be taken for life, but with a life expectancy comparable to that of the general population. However, we must work on the ability to intercept the underground economy because the path is simple, once it is managed in the competent centres”. Moreover, “compared to 15-20 years ago the picture has really changed – he underlines – for me it was an exceptional path, but we must have the courage to change the paradigms followed until now. Treating the patient close to home is the objective of the next 5-6 years, but to achieve the WHO objectives we must work on the informal sector, making it clear that taking the test should not cause shame, but gives advantages”.
Stigma remains “a crucial topic throughout the history of the disease – recalls Antinori – We know that people with HIV on stable antiretroviral therapy and suppressed viremia do not transmit the infection. The risk of transmission, even through unprotected sexual intercourse, is zero. This – he reiterates – must be communicated because it is a strong destigmatizing element because these people no longer represent the danger of ‘being a source of infection’, as felt in the early years. It’s about understanding that these people have the needs of those with chronic illnesses, such as hypertension and diabetes, which are not burdened by such a strong stigmatization because they have different cultural contents.” Regarding the care of newly diagnosed people, “while the majority of patients will have therapy quickly – observes Badia – the offer of other types of support by the centers is more variable. After a diagnosis, psychological support, for example, is useful, but discussion with peers is also needed to address doubts and practical issues. This is an opportunity that our center is able to provide thanks to the agreements with the associations that are present in the Bologna area”.
In the coming years “there are different priorities – summarizes Antinori – Recovering the people who are lost, the most fragile, who risk not remaining connected to the care center: an effort is needed, not only clinical, but also social and institutional. We must then reduce the incidence of new diagnoses and the spread of infection with Prep, pre-exposure prophylaxis. We need resources and a new organization of infectious disease centers to offer it, but also to “activate” the check points of patient associations. It’s a great challenge: we can also do a lot in prevention, but – he concludes – it must be taken up by the institutions”.
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