The advent of effective therapies against HIV has long changed the face of this pathology. Today, people who receive this diagnosis “live longer”, but are still under the burden of an experience of guilt, known as “stigma and, above all, self-stigma”. New “long-acting treatments” can be of help not only from an infectious point of view, but also for the “psychological aspect”. This was explained by the experts who spoke at the webinar ‘How to increase the quality of life of the person with HIV today?’, the second appointment of the column ‘Let’s talk about HIV today. To look to tomorrow’, promoted by Adnkronos in collaboration with ViiV Healthcare, broadcast today and available on the publishing group’s web and social channels.
“In the person with HIV there is always an aura, a burden”, a sense of guilt “that is difficult to scratch. Having other pathologies linked to aging which then cause polypharmacy”, that is, having to take more of 5 pills a day, “respecting schedules and having checks make these people’s ‘feeling sick’ even worse”, says Miriam Lichtner, full professor of Infectious Diseases, Department of Neuroscience, Mental Health and Sense Organs (Nesmos), Sapienza University of Rome, guest of the event together with Silvia Nozza, infectious disease doctor of the Infectious Diseases Unit of the Irccs San Raffaele Hospital in Milan, and Maurizio Amato, CEO of ViiV Italia.
“Stigma and self-stigma – explains Nozza – refer to the fact that the person with HIV infection”, even if with therapy comes to have “a negative viral load, therefore is not able to transmit the virus”, according to the principle U =U (undetectable = untransmittable), “you can still feel sick because” taking the therapy daily, for example, means “always remembering that you have HIV infection” and this can also affect the sphere of social relations”. At the moment “technological innovation brings us therapies which, for example, can be taken once every 2 months – underlines Lichtner – They are the so-called long acting drugs, which have a long-lasting action. They are inoculated intramuscularly – 2 injections which are done at the same time and which then last in the blood for 2 months – freeing the person from the slavery of taking therapy every day for life. It is a great opportunity.” More and more patients “adhere to these therapies with great enthusiasm because they feel like they have liberated the concept of feeling sick”.
Freeing yourself from taking daily therapy has an impact on an emotional level. “There are various scientific publications – underlines Nozza – One, also made in our centre, shows how the decision of a person with HIV infection to take therapies that are no longer daily, but every 2 months, or – more futuristically – pills to be taken once a week represents an important improvement in the quality of life”. There are some molecules that “can be stable for six months, even for a year – explains Lichtner – They are administered, for example, with subcutaneous implants or in long-acting tablets. Think of a therapy that is taken only once a year it is truly something that almost resembles the vaccine, from the point of view of timing. We have been working on it for years, but we cannot overcome the concept of stigma and so, when a person knows they have this infection, he discriminates against himself. It’s not so much what happens in society: the biggest obstacle is precisely against himself”, in experiencing the infection “as a fault”. We must therefore work both on “a culture of welcome”, but also “of acceptance”, which “probably – the specialist points out – does not only concern HIV”.
The “most important challenge – reiterates Nozza – is that the person with HIV infection does not feel like a patient, but part of a society, knowing that he simply has a positivity to a virus perfectly controlled by therapy. This is certainly a challenge that must be played on different levels for people with the infection. I believe it is essential that, to achieve these objectives, less impactful therapies are made available from the point of view of side effects and use, for example long acting therapies, which have arrived quite recently, are certainly a model to follow and improve from a practical point of view”.
In this area “it is essential that drugs reflect the needs of clinicians and patients – highlights Amato – The first need is to continue working with a team spirit between industry, clinical research – therefore professionals in the health area – and with same patient communities. Another very important effort is to ensure that this innovation, once created, is actually made available to people living with HIV, in the case of therapy”, but also “to potential subjects interested in PrEP, pre-exposure prophylaxis – he concludes – also requires collaboration with institutions, to ensure that access barriers are overcome and that drugs are promptly made available to those who can benefit from them, especially when we are talking about drugs that represent an answer to unmet needs, drugs of innovative value”.
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