Consistently low levels of detectable HIV increases the risk of developing cancer.
Human immunodeficiency virus (HIV) infection continues to be a priority public health problem in Spain. There are an estimated 130,000 to 170,000 people living with HIV in our country. There were 2,956 new HIV diagnoses in 2022, of which more than half were men who have sex with men—a group in which the rate of new diagnoses showed a downward trend between 2018 and 2022. Since 2017, there has been a downward trend in overall rates and by gender.
Spain has made real and effective progress towards the UNAIDS 2030 targets of 95% of people diagnosed, 95% of people diagnosed on treatment and 95% of treated cases with undetectable viral load) to achieve zero viral load. new infections and minimizing mortality and development of AIDS events. Our country is currently exceeding the second target (people on treatment) with 96% compliance, and the first target (people diagnosed) is gradually approaching this figure, with an estimated 7.5% of people living with HIV among us , have not yet been diagnosed. . For the third case (treated cases with undetectable viral load), almost 10% of treated patients are those who fail to achieve viral suppression.
Among this percentage there are people who have what is called Persistent low-grade HIV viremia.– is defined as plasma HIV RNA concentration between 50 and 200 copies/ml, and this condition may increase the risk of developing cancer, according to a study by the National Center of Microbiology of the Carlos III Health Institute.
A study led by Veronica Briz and Violeta Lara Aguilar of the National Center for Microbiology (CNM) found an adverse immunological footprint in HIV-infected people with low-grade viremia treated with integrase inhibitors. activation and aging. Article published in the magazine Journal of Biomedicine‘.
Immune exhaustion
This phenomenon can lead to accelerated depletion of immunity, which may increase the risk serious events not related to HIV, such as malignancies and cardiovascular diseases, as reported by ep.
Antiretroviral treatment has improved the quality of life of many people with HIV infection, although failed to completely reverse the effects of viral infection on the immune system. HIV has been shown to cause dysregulation of immune responses, resulting in a depleted immune system in people with HIV compared to the general population, resulting in increased risk of developing concomitant diseases.
Researchers explain that HIV replicates predominantly in T lymphocytescausing progressive failure of the immune system. The results of this study show that people with HIV demonstrate different immune profile than the general population, with greater activation, senescence and cellular inflammation, and various changes that affect CD4+/CD8+ cells, IL-13, and naïve CD8+ T cells, among others.
The essay concludes that Low-grade viremia of 50 to 200 copies/mL results in decreased cytotoxic activity and T cell dysfunction. which can affect the production of cytokines that will not be able to control and destroy infected cells.
In addition, an increase in aging markers suggests progressive loss of immunological memory and decreased proliferative capacity of immune cells. This accelerated immune depletion may contribute to the risk of pathologies associated with aging, highlighting the need mitigate the effects of low-grade viremia in these individuals.
Reprogram your immune system
In a second investigation, CNM concluded that treatment with immunomodulatory drugs such as ponatinib in combination with antiretroviral therapy, It may be effective in enhancing the antiviral activity of cytotoxic cells and promoting the elimination of the viral reservoir in cases of HIV infection.
Work carried out by the Maite Koiras group and published in Frontiers in pharmacology, showed in vitro that Short-term treatment with immunomodulatory drugs may represent an alternative method for gradually reprogramming the immune system against the HIV viral reservoir.
The study involved 23 patients treated with ponatinib, a tyrosine kinase inhibitor (TKI) used against chronic myeloid leukemia (CML) that has also been shown to be effective against HIV infection in vitro. The study assessed the ability of this drug in peripheral blood mononuclear cells to induce the development of cytotoxic cell populations with anticancer and antiviral activity, according to Ep.
The results show that CD4+ T cells are resistant to HIV infection during treatment with ponatinib and for 1 year after stopping the drug, so this study suggests a new strategy by which patients could perform temporary treatment with immunomodulatory drugs that reprogram the immune system for the purpose keep reservoir cells under control in the absence of antiretroviral treatment.