La Dra. Irini Sereti ofrecerá la segunda ponencia inaugural del XIII Congreso Nacional de GeSIDA. En esta entrevista avanza algunos de los aspectos que tratará en su ponencia, así como otras cuestiones de relevancia en el abordaje del VIH.
What are the causes and consequences of residual inmune dysfunction under ART?
I will focus mostly on the role of HIV itself (persistent infection), CMV and other co-infections as well as the role of persistent CD4 lymphopenia esp in people who are late presenters and start therapy with low CD4 counts. The consequences are chronic inflammation, decreased responses to vaccine in people with lower CD4 counts and higher morbidity and mortality from non-infectious complications such as cardiovascular disease and non-AIDS malignancies.
One of your main lines of research focuses on inflammatory complications in HIV. What are the latest advances in this area and most important challenges to deal with?
The biggest challenges are that peopel still get diagnosed late in the course of HIV with low CD4 counts so their immune restoration may not be complete as shown in persistent inflammation and worse response to vaccines for example. Another big challenge is that the average age of the majority of people with HIV is now over 50 so diseases of aging and inflammaging are big considerations to quality of life, morbidity and mortality.
Immunological therapies are also another of your specialties. What would you highlight in this regard?
I will highlight economy of approaches, meaning optimizing existing therapies as we wait for results from large randomized trials in th enear future and for scalable remission strategies in the more distant future. For antiretrovirals, we need to compare which ones have better inflammatory profile, we need to address comorbidities and we need to diagnose and treat peopel at the earliest posible stage of the disease. This is what we know works the best and as recent studies have suggested this may also be the stage where interventions for remission could be more effective.
Five years ago you published a study on the benefits of using tick saliva as a potential treatment for reducing HIV-linked heart disease risk. What other lines of research are you currently working on?
I think at this point the best trials to watch is REPRIEVE which will be discussed by Dr Grinspoon and also the trial of letermovir being done by Dr Hunt to look at the impact of targeting CMV. Anticoagulants tested before had no effect in suppressed people with HIV (TACTICAL and ADVICE clinical trials). We have not pursued the anti-coagulants further. Our main interest now is to understand how chronic inflammation and aging may intersect and affect disease progression and what potential strategies could be tested for this.