“Nobody saves himself alone”. The words launched by Pope Francis in a deserted St. Peter’s Square in March 2020 sound prophetic once again. Prophetic because if we do not “vaccinate the world” the pandemic will last longer. But there is a particular aspect that ties universal access to drugs and vaccines and Covid-19 together. World AIDS Day is celebrated on 1 December.
We have plenty of effective treatments but these are not always equally distributed. And it is precisely the lack of treatment of HIV-positive people one of the possible causes of the genesis of new variants. Indeed, it is in individuals with chronic infections such as AIDS patients that the virus finds fertile ground to evolve. That’s why addressing global health challenges in their entirety is more critical than ever.
HIV, first human trial to eradicate the virus with genetic editing
by Giuliano Aluffi
What are viral variants?
Any virus, when it multiplies, brings with it “copying” errors in its genetic code. Sars-Cov-2 is no exception. From the first known sequence filed at the beginning of January 2020 to date, there are many mutations that have been created. This is a completely natural phenomenon. The more the virus multiplies, the more it is prone to errors. When mutations accumulate over time or in any case when certain particular conditions occur (such as infection in immunocompromised people) it can happen that the virus changes its characteristics to the point of giving rise to a viral variant compared to the original virus.
Omicron, still early to draw conclusions
Although most mutations do not have a significant clinical impact, some may give the virus some characteristics such as a selective advantage over others through greater transmissibility, greater pathogenicity with more severe forms of the disease, or the ability to bypass the disease. immunity previously acquired by an individual either by natural infection or by vaccination. As for the Omicron variant, isolated on 11 November in South Africa and now already reported in Europe and the United States, to date all these characteristics have yet to be evaluated.
HIV, what happens when therapy is stopped
by Giuliano Aluffi
Poor vaccinations …
While waiting to know in detail the impact of Omicron mutations – in particular on the possible reduction of the vaccine efficacy to be demonstrated -, the scientists are working in an attempt to decipher the origin of this variant to understand if it is something that has already been around for a few months or if it is the result of a recent “evolutionary leap”. One thing is certain: where a virus circulates unchecked, the probability of generating variants is higher. Not only that, this phenomenon is more likely to happen in those countries where vaccination coverage is very low, such as, for example, the African continent.
… and the role of HIV
But in this area of the world there is another virus, HIV, which can play an important role in the genesis of new variants. Several studies in recent months have shown that chronic Sars-Cov-2 infections in immunocompromised individuals (or treated with hyperimmune plasma) can lead to the development of viral variants. A sort of “incubator” that would allow the virus to select the most advantageous mutations. And this is what appears to happen in HIV-positive individuals who are not treated properly. Analyzing the evolution of the many variants that emerged in recent months, many originated in the African continent and in particular in southern Africa.
As for Omicron, although its birth in South Africa remains to be proven, the data on HIV leave little room for interpretation. In this state, one in 5 individuals is HIV-positive but only 70% of these people have access to antiretroviral therapies that allow optimal control of HIV. Therefore HIV – and in particular its lack of treatment – could represent a driving factor in the genesis of new variants and as such, access to antiretroviral therapies should be even more priority not only for the health of the person but with a view to contrasting COVID-19.
Hiv, after Covid we start again. From the difficulties of the sick
HIV in Italy
But be careful to think that the difficulty in accessing HIV therapies is characteristic of the African continent alone. In our country, for example, despite having effective antiretroviral drugs available, access does not occur due to a lack of HIV diagnosis. In Italy, as reiterated by the Istituto Superiore di Sanità, for some time we have begun to witness increasingly late diagnoses.
Six out of ten of new HIV diagnoses are identified late, that is, in people with severely impaired immune status or even already with symptoms of AIDS. A delay that affects the effectiveness of antiviral therapies. Today, if treated early, an HIV-positive person has the same life expectancy as a person who has never been in contact with the virus. An unthinkable result only in the early 90s when the diagnosis was equivalent to a sentence.
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