La primera vacuna que frena el VIH

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Cinco pacientes de Barcelona son los primeros del mundo que han conseguido controlar el virus del sida (VIH) con su sistema inmunitario tras recibir una vacuna terapéutica.

Los pacientes, que habían recibido tratamiento antirretroviral durante más de tres años, han dejado de tomar la medicación sin que el nivel de VIH en su sangre haya aumentado por ahora. Uno de los casos ha estado sin tratamiento durante más de seis meses. Los otros lo han estado entre cinco y veinte semanas.

Otros ocho pacientes que han recibido la misma vacuna han tenido que volver a tomar antorretrovirales porque, en su caso, el virus sí ha rebrotado. Los médicos aún no han descubierto por qué la vacuna ha funcionado en unos pacientes y no en otros. Tampoco saben cuánto tiempo durará la eficacia de la vacuna en las personas en las que sí ha funcionado.

Efecto duradero

Uno de los casos ha estado sin tratamiento antirretroviral durante más de seis meses

“Es la primera vez que se demuestra que podemos controlar el virus con una vacuna terapéutica”, declara Beatriz Mothe, investigadora del instituto IrsiCaixa y codirectora del estudio. Después de doce años de trabajo en este proyecto, “es la prueba de que vamos por buen camino”. Pero la vacuna, recalca Mothe, es experimental y aún no está a punto para aplicarse a grupos amplios de pacientes.

La investigación, presentada en la Conferencia sobre Retrovirus e Infecciones Oportunistas que se celebra en Seattle (EE.UU.), se inspira en los llamados controladores de elite del VIH. Son personas a quienes les basta con su sistema inmunitario para mantener el virus del sida a raya y que por lo tanto no necesitan tomar antirretrovirales. Se estima que entre un 1% y un 2% de portadores del VIH son controladores de elite.

“Si se consigue educar el sistema inmunitario de otros portadores de VIH con una vacuna de modo que actúe igual que el de los controladores de élite, podrían dejar de tomar antirretrovirales de manera crónica como deben hacer ahora”, explica Bonaventura Clotet, director de IrsiCaixa.

Voluntarios seleccionados

La vacuna se ha ensayado con éxito en personas que habían sido diagnosticados poco después de contraer la infección

Para comprobar si este planteamiento era correcto, la investigación se ha basado en personas en las que la infección por VIH se diagnosticó poco después del contagio. Esto les permitió iniciar el tratamiento antirretroviral antes de que el virus causara estragos en su sistema inmunitario. Los médicos razonaron que este tipo de personas son las que tendrían más probabilidades de responder a una vacuna

Veinticuatro voluntarios recibieron una primera dosis de vacuna hace tres años en el marco de un estudio para comprobar si el producto era seguro. Una vez superada con éxito esta fase, se ha realizado un segundo estudio para comprobar si la vacuna es eficaz. En este segundo estudio han participado quince de aquellos veinticuatro voluntarios.

Investigaciones anteriores han demostrado que, incluso en pacientes que tienen el VIH indetectable en la sangre, el virus se atrinchera en los llamados reservorios. Allí se queda inactivo, en estado quiescente, esperando la ocasión de proliferar de nuevo. Esto explica que, cuando se ha intentado retirar el tratamiento antirretroviral a personas que tenían el virus indetectable en la sangre, este haya rebrotado siempre en un plazo máximo de cuatro semanas.

Con estos antecedentes, los investigadores han decidido complementar la vacuna con un fármaco que activa el virus de los reservorios y lo hace salir de su escondite. La lógica de este tratamiento es que, cuantos menos virus queden en los reservorios, más probable será después que el sistema inmunitario pueda frenarlo con la ayuda de la vacuna.

Para hacer salir los virus escondidos, los voluntarios han recibido tres dosis de romidepsina, un fármaco aprobado en Estados Unidos para el tratamiento de algunos cánceres. Han recibido asimismo dos dosis de la vacuna, una antes y la otra después del tratamiento con romidepsina. La vacuna que se ha utilizado, llamada MVA.HIVconsv, fue desarrollada hace doce años por investigadores de la Universidad de Oxford (Reino Unido).

Carrera de fondo

Pueden faltar entre diez y quince años para conseguir una vacuna eficaz para todos los portadores del VIH, destaca Bonaventura Clotet

Según los resultados presentados ayer en Seattle, esta estrategia está funcionando en cinco personas y no ha funcionado en ocho. “Son resultados preliminares, pero alcanzamos un 40% de control”, destaca Christian Manzardo, del hospital Clínic, que también ha participado en la investigación. De las dos personas restantes no hay datos.

Otros dos estudios presentados anteriormente habían intentado reproducir los efectos de los controladores de elite con vacunas, informa Beatriz Mothe. Este, sin embargo, es el primero que consigue resultados positivos. Los investigadores atribuyen el éxito al tipo de vacuna que se ha utilizado, al fármaco elegido para expulsar el virus de los reservorios y a la selección de los participantes en el estudio.

Pero “nos queda mucho trabajo por hacer”, advierte Bonaventura Clotet. Los próximos objetivos de la investigación incluyen aclarar por qué la vacuna sólo funciona en algunas personas y comprobar durante cuánto tiempo se mantiene su eficacia. A más largo plazo, el equipo de IrsiCaixa aspira a “conseguir una vacuna eficaz para toda la población infectada”, destaca Clotet. Esta vacuna no sólo debería funcionar en personas diagnosticadas poco después de contraer el VIH como las que han participado en este estudio, sino también en personas que llevan décadas conviviendo con el virus. Para conseguir esta vacuna para toda la población “pueden faltar diez o quince años”, calcula Clotet.

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Es la primera vez que se demuestra que podemos controlar el virus con una vacuna terapéutica

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