Terapia anti retroviral / Antiretroviral therapy

There are treatments to induce the long term suppression of viral replication and that delays the progression of HIV disease. To be effective, these treatments require the uninterrupted use of a combination of drugs (ideally three), patients must be highly compliant, must be instituted in early stages of the disease and drugs must be used for prolonged periods and given by specialists. These treatments are indicated in all symptomatic patients and in those with early immunologic deterioration or high viral load. Recent infection and acute primary retroviral infections should also be considered for treatment. The treatment sponsored and financed by the ministry of health for its beneficiaries is insufficient at this time, since it is received by a minority of eligible patients due to budgetary reasons, and only two drugs are given which is considered sub optimal by most experts. The committee considers that the responsibility for financing, providing and delivering these treatments in proper combination and dosages exceeds the duty of the Ministry of Health and should include all the involved parties. However, the state and its official institutions have a special responsibility to provide with adequate treatments to the poorer segments of our population. They also should promote, supervise and control the proper access of the rest of the population to efficient treatments. The committee also considers that the efforts to prevent new infections must not be neglected and that individuals under successful treatment should not consider themselves as non infectious

Declaración sobre el uso de terapia antiretroviral en pacientes infectados por virus de inmunodeficiencia humana / Statement about antiretroviral therapy use in HIV positive patients

The Committee based its postition paper on the following fact: existence of an effective way of inducing long term suppression of viral replication which in turn is associated with delayed progression of HIV disease. In order to reach this aim, the treatment requires to be: given in combination of drugs (ideally 3), highly compliant, not interrupted, iniciated early, prolonged and carried out by specialists. This treatment is indicated in all symptomatic patients and those with early immunologic deterioration and/or high viral load. Recent infection and acute primary retroviral infection should also be considered for treatment. General criteria for treatment of children (including newborn) are given. The treatment sponsored and financed by the Ministry of Health for beneficiaries of the public health system at this time in insufficient since only a minority of elegible patients receive it due to budgetary reasons and, because only 2 drugs are given, is considered by most experts as suboptimal. The Committee considers that the responsability for financing, providing and delivering of these treatments (in proper combination and dosages) exceeds the duty of the State and Ministry of Health and should include all the parties involved and that the society as a whole should respond generously and solidariously. However, the State and its official institutions have a special responsibility with the poorer segments of the populations in orden to provide them with medically proven treatments and besides that cannot resign the other responsability of promoting, supervising and controlling the mechanisms ensuring proper access to adecuate treatment of non public health system beneficiaries. The Committee also considers that the efforts to prevent new infections in the populations should not be abandoned but intensified and that people under treatment, however succesful, should not consider themselves as noninfectious

Posición sobre los estudios serológicos de la infección por virus de inmunodeficiencia humana / Statement about serologic screening for human immunodeficiency virus infection

At present there are adecuate tests for diagnosing VIH infection, both for screening (ELISA) and confirmation (western blot) purpose. Polimerase chain reaction (PCR) and P24 antigen tests can be used for viral detection in infants before the age of 18 months (including neonatal period), before antibody seroconversion and in serologically indetermined cases. The Chilean Infectious Disease Society Advisory Committee on AIDS (CC-SIDA) strongly recommends that the following principles be followed in ordering/performing HIV diagnostic tests: informed consent (although under unusual and restricted circumstances in which the well being of third parties is involved this requirement can be waived), confidentiality of the information. Professional councelling before and after test is performed. For public health purposes it should be performed in all blood, blood products and germinative tissue as well as organ and tissue donation. It should also be performed anonymously in various population to monitor the evolution of the epidemic. Pregnant women should be encouraged to have the test performed in order to minimize vertical transmission through antiretroviral therapy. In non health care settings it should not be performed. Specifically it should not be a requirement in applying for job or education, obtainig life or health insurances, visa or authorization for crossing frontiers