Hospital demand for Covid-19 leaves HIV patients at INER without services

25/03/2020

The collapse of medical services in Mexico has led institutes such as the Center for Infectious Disease Research to give priority to people infected with coronavirus.

HIV test. Stock photo
HIV test. Stock photo

Both the Institute of Respiratory Diseases (INER) and the Center for Infectious Disease Research (CIENI) are suffering from saturation of their services in the face of the health crisis generated by the coronavirus.

INER, as a national health institute, serves the largest number of people with HIV/AIDS infection, which is considered one of the causes of institutional death from infectious diseases in hospitalized people within the age range of 18 to 45 years.

CIENI, on the other hand, operates as a department of INER, in charge of the care of patients with HIV/AIDS. However, it recently announced the cancellation of sampling and hospitalization of the population affected by this disease.

In view of this, patients who are carriers of the acquired immunodeficiency virus and require these services will have to wait until June, since priority will be given to stay and care of that part of the population affected by Covid-19.

The degree of hospital demand in the health sector, which has been generated by the pandemic that is sweeping the world, has prevented the necessary medical attention from being given; even, in relation to the recently created Institute of Health for Welfare (Insabi), the same Undersecretary of Prevention and Promotion of Health, Hugo López-Gatell said on Tuesday 24 March that it still does not have sufficient medical personnel to operate.

In relation to the recruitment of human resources, Lopez-Gatell said that only a little over 1200 people have been recruited, out of a total of 43,000 contemplated to provide coverage to the health services of the recently created Institute and decentralized body of the Ministry of Health.

With respect to the Institute of Respiratory Diseases, the same staff has confirmed that medical care has been affected, to the extent that they have asked other health centers to open their referral, so that patients who cannot be served by INER, get to be hospitalized in other health centers, if required.

Regarding the incidence that the coronavirus could have on patients with HIV, the Spanish Society of Immunology (SEI) explained that, to date, there are no indications that confirm that having HIV implies a greater risk against the coronavirus, and therefore it emphasizes that the message it sends regarding this disease in accordance with the current world context is one of peace of mind.

Although the SEI said that data are still scarce, for the time being, there are indications that people with HIV who have strong immune systems are at greater risk of contracting or evolving Covid-19.

In the same vein, these specialists noted that all those people taking antiretroviral treatment who have CD4s above 500 cells/mm3 can expect their results to be similar to those of similarly situated HIV-negative people.

In contrast, if there is a higher risk, they point to patients with weaker immune systems, i.e. CD4 counts below 350 cells/mm3, as being at greater risk.

For both populations, the SEI recommends:

Maintain proper hygiene, wash hands frequently with soap and water, for at least 20 seconds or with an alcohol-based disinfectant, with at least 60% of that disinfectant.

Use tissues when sneezing or coughing into the inner corner of the arm (label sneeze). If you use tissues, immediately throw them in the trash.

Avoid contact with people who are sick or keep a distance of at least two meters with people who have symptoms of respiratory infection (fever, cough, generalized muscle pain, sore throat or difficulty breathing), in addition to not sharing personal belongings with them.

Stay home if you are sick to avoid the likelihood of transmitting the infection to your co-workers and to keep them productive when they are better.

Trying to follow a good diet, as the spread of respiratory infections depends largely on the strength of the immune system, is key to your body.

They also do not recommend the use of face masks, as well as avoiding large crowds, the consumption of tobacco and alcohol, and avoiding travel if you have a fever and a cough. In the case of suspected infection, the SEI states that this population must follow the instructions of the corresponding health authorities, indicating their particular medical situation.

11,000 NEW HIV INFECTIONS EACH YEAR IN MEXICO, 45% IN YOUNG PEOPLE

Without a doubt, the HIV epidemic continues to be a public health problem in the country, and it is estimated that 230,000 people are living with HIV in Mexico.

A little more than 11,000 new HIV infections are registered in Mexico each year, 45 percent of which are among young people between the ages of 15 and 29, which is a source of alarm. Alethese de la Torre, director general of the National Center for the Prevention and Control of HIV/AIDS (Conasida), acknowledged the above, highlighting that Mexico and the world are far from ending this epidemic.

"Undoubtedly the HIV epidemic continues to be a public health problem in our country, and it is estimated that 230,000 people are living with HIV in Mexico; for various reasons, thousands of people do not have access to information or supplies needed to prevent new infections, in the period from 2014 to 2018 were recorded 68,807 new cases of HIV," she said.

Within the framework of the commemoration of World Day for the Fight against HIV/AIDS, Hector Miguel Corral, a Conasida citizen, raised his voice to claim on behalf of civil society the crisis by the lack of antiretrovirals in the country and the elimination of support to non-governmental organizations in prevention tasks, which from 2006 to 2018 received funding for 777 million pesos, through public calls.

"Still in different parts of the Republic, cases of shortage of antiretrovirals continue to be reported, due to the difficulties that arose in the process of purchase and distribution, from the changes implemented by the current administration, which endangers the viral suppression and quality of life of people living with HIV," he lamented.

In response, Hugo López Gatell, Undersecretary of Prevention and Health Promotion explained that the lack of antiretrovirals was due to the fact that they sought to improve treatments with high quality, safe and effective supplies, but also to protect the public finances of different private interests, generally speculative, which led the country to pay an unjustified surcharge.

"The net result that everyone knows is that today we have the most complete, most modern antiretroviral treatment scheme in Latin America, and not only that, but we also managed to have it at half the cost. In society, in the public media, there has been a desire to emphasize the issue of cost as if we had had the intention of saving instead of what it really was and continues to be for the other elements, the intention of having the best elements but also at the best possible cost," he said.

The shortage of antiretrovirals is registered in the last part of the distribution of inputs, when they are already in the central warehouses and the state authorities have problems to deliver them to the health units and institutions.

Another factor is that there are still bad practices of public servants, such as those responsible for pharmacies, which simply do not want to supply antiretrovirals, so he urged citizens to denounce any failure to the right to universal health care with access to free medicines.

Regarding the lack of budget for civil society organizations, after conducting a study, the Ministry of Health realized that there is no clear evidence that this mechanism has achieved the maximum possible effect on prevention tasks, since 50 percent of people who come for the first time to receive treatment for HIV infection do so when "it is too late and there is catastrophic damage to their immune system, because it took between 7 and 10 years to know they had this disease".

World AIDS Day: HIV in numbers

HIV, the virus that causes AIDS (the final stage of infection), remains a serious global public health problem. So far it has caused 32 million deaths worldwide.

However, if patients have access to effective diagnosis, treatment and care, the disease can be controlled and a patient can live a normal life.

24.5 million people had access to antiretroviral therapy by the end of June 2019, according to UNAIDS, the Joint United Nations Programme on HIV/AIDS.

By 2018, 37.9 million people were living with HIV. About 8.1 million knew they had the virus.

But having HIV does not mean having AIDS. To be infected with HIV (human immunodeficiency virus) is to have been exposed to the virus, but you don't necessarily have to develop the disease (acquired immunodeficiency syndrome).

More than half of infections in Africa

In developing regions, AIDS is currently particularly prevalent.

A total of 25.6 million people living with HIV live in Africa, the most affected region in the world. This represents 67% of the world's total. In addition, it is estimated that almost two out of every three new infections occur on this continent.

Political instability and the lack of financial resources are the main obstacles preventing African governments from addressing the epidemic. This hampers access to medicines and health care.

In developing countries, antiretroviral therapy was not introduced until about 2003, almost a decade after its introduction in Western countries. In that time, millions of people died.

International cooperation is essential to combat AIDS in these regions. Despite this, investment has declined in recent years: by the end of 2018, aid was estimated to have fallen by almost $1 billion compared to the previous year.

Future plans

Among the UN's Sustainable Development Goals (SDGs), one of the most important goals is to completely eradicate the global AIDS epidemic by 2030.

By then, by 2020, UNAIDS has set itself the challenge of 90-90-90: to make 90% of people living with HIV aware of their positive status, 90% have access to antiretroviral therapy and 90% have undetectable rates of the virus in their blood, which would mean that they cannot transmit it.

Myth: Having HIV means you have AIDS

HIV and AIDS have constantly been heard as synonyms, however, it is important to clarify that they are not and a diagnosis of the Human Immunodeficiency Virus does not always mean condemnation for the person who has acquired it.

The virus attacks the defense cells of the human body called CD4 T-lymphocytes, altering or nullifying their function. The infection causes a progressive deterioration of the immune system and when uncontrolled, evolves more rapidly into what is commonly known as AIDS and is defined by the presence of any of the more than twenty opportunistic infections or HIV-related cancers.

The virus is found in blood, sex organ fluids (pre-ejaculatory fluid, semen, vaginal discharge) and breast milk and can, therefore, be transmitted through vaginal, anal or oral sex with an infected person, transfusion of contaminated blood or sharing of needles, syringes or other sharp instruments. It can also be transmitted from mother to child during pregnancy, childbirth, and breastfeeding.

Once HIV is inside the body's cells, it uses them to replicate without causing any prior discomfort, which is why this stage is known as asymptomatic. It is because of this stage that the infected person is not treated promptly and some discomfort is detected when the infection has evolved into such a disease.

Without early diagnosis and treatment, there is a greater chance that HIV infection will develop into AIDS, which is why life expectancy and quality of life are considerably reduced.

Currently, the only way to know if you have HIV is through a laboratory test that detects antibodies against the virus in blood or saliva and the way to treat infected people is through various antiretroviral drugs and comprehensive medical care that allow increasing life expectancy and quality of life.