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Operaio morto a 38 anni dopo essere caduto da un'impalcatura a casa del figlioHiv,ETF esperti: "Dialogo, personalizzazione e attenzione ad aspetti pratici essenziali per aderenza terapeutica" di Adnkronos   17-07-2024 - 10:30 Link copiato #iubenda-cs-banner .iub_ts_bc:not(.iubenda-custom-content) *,#iubenda-cs-banner [class*=" iub"],#iubenda-cs-banner [class^=iub],.iubenda-tp-btn:not([data-tp-nostyle]){ 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background-color: #fff; border-radius: 0.5rem; box-shadow: 0 12px 24px rgba(0, 0, 0, 0.12); font-family: sans-serif; content: 'Loading...'; display: flex !important; font-size: 13px; font-weight: bold; line-height: 1; justify-content: center; min-height: 50px; text-transform: uppercase;}#speakup-player:empty{ display: block;} (Adnkronos) - Oggi le persone che vivono con Hiv, grazie ai progressi della ricerca e alle nuove terapie, hanno un'aspettativa e una qualità di vita molto superiori rispetto al passato. L’avanzare dell’età, però, li espone spesso alle comorbilità che altre patologie legate all’invecchiamento possono provocare, con conseguente necessità di dover seguire terapie anche per altre patologie croniche. Un aspetto, questo, che può influire sull’aderenza alla terapia antiretrovirale, in particolare per quella orale, che richiede costanza e regolarità da parte del paziente. L’aderenza, infatti, può essere faticosa per chi deve assumere una terapia tutta la vita, specie se quotidianamente. “Nei pazienti che hanno comorbidità o che per altre questioni seguono politerapie, cioè che assumono già una terapia per via orale fatta di più compresse, la terapia antiretrovirale deve essere il più semplice possibile, perché tra l'altro la pillola della terapia per l'infezione da Hiv a volte per il paziente ha un “sapore diverso”, in senso metaforico chiaramente, perché è associata comunque a un peso psicologico”. Lo spiega Antonella Castagna, direttrice della Clinica di Malattie infettive dell'università Vita-Salute San Raffaele, Istituto scientifico San Raffaele di Milano.“È importante trovare strategie che ricordino il meno possibile alla persona di essere Hiv positiva”, osserva Gabriella d’Ettorre, professore associato di Malattie infettive all’Università Sapienza di Roma, che prosegue: “ma un altro aspetto che contribuisce ad aiutare l'aderenza alla terapia è la spiegazione alla persona che vive con Hiv di quello che andiamo a fare insieme. Gestire l'infezione significa assumere una terapia che tenga sotto controllo il virus e soltanto nel momento in cui noi medici rendiamo edotta la persona di quello che è il compito della terapia e di quello a cui si può andare incontro nel momento in cui non la si assume, allora si stabilisce un'alleanza medico-paziente che diventa un'alleanza terapeutica che contribuisce all'ottimizzazione dell'aderenza alla terapia”.“Bisogna conoscere il paziente e, al di là dei progressi delle terapie, risulta essenziale il rapporto fra medico e paziente per la riuscita della cura”, rimarca Elio Manzillo, direttore Uoc Immunodeficienze e Malattie dell'immigrazione, Azienda Ospedaliera Specialistica dei Colli, Ospedale Cotugno di Napoli. “Il percorso terapeutico non è una mera distribuzione di farmaci o convincere il paziente che il farmaco che gli si sta somministrando sia il migliore - prosegue - il paziente va portato per mano e seguito”."A volte si pensa all'aderenza terapeutica come a un insieme di fattori molto difficili da gestire - e in parte è vero anche se le terapie antiretrovirali di oggi ci hanno molto semplificato il compito - ma direi che l'ascolto del paziente e un approccio personalizzato sono fondamentali. E probabilmente dobbiamo fare ancora un po' di strada su questo aspetto”, sottolinea Castagna."Il messaggio chiave - specifica D'Ettorre - è che ogni persona è singola, è diversa dall'altra, non esiste la terapia adatta a tutti, esiste la terapia che deve calzare bene alla singola persona".In quest'ottica, soprattutto per quanto riguarda la terapia orale, anche piccole attenzioni, come un packaging compatto e discreto e che, grazie all’indicazione dei giorni della settimana, aiuti a tenere il conto delle pillole, possono essere importanti per favorire l'aderenza alla terapia.“Assolutamente, fra l’altro ne abbiamo un'esperienza diretta quando conduciamo gli studi clinici dove c'è una verifica molto più stringente del numero di pillole consegnate al paziente e restituite; quindi, tutto ciò che sembrano piccoli dettagli, ma che favoriscono l'assunzione della terapia in modo semplice, ha degli impatti anche sull'aderenza alla terapia e, in generale, sulla qualità di vita”, argomenta Castagna."Spesso ci sfugge che dover portare delle compresse con sé e magari aver bisogno di conservarle in un dato modo può non essere sempre facile per la singola persona, in base a quella che è la sua vita. Quindi anche il confezionamento dei farmaci diventa un aspetto importante che le aziende, devo dire, tengono in considerazione non solo per un discorso di conservazione e di trasporto ma anche per aiutare i pazienti a non dimenticare l'assunzione del farmaco. Questo è un aspetto importante perché siamo di fronte a un'infezione cronica e proprio questa cronicità di assunzione dei farmaci può essere poi causa di dimenticanza nella quotidianità", aggiunge D’Ettorre.Si comprende bene, dunque, come anche un packaging che incontra le esigenze di flessibilità del paziente, assume un ruolo non trascurabile nel difficile equilibrio psicologico che una aderenza terapeutica ottimale richiede.Peraltro, le persone che vivono con Hiv sono coscienti di avere più opzioni terapeutiche a disposizione, esponendoli però anche al rischio di una minore aderenza: “Essere consapevoli di avere a disposizione più opportunità terapeutiche efficaci e meno tossiche spesso fa sì che si abbassi il livello di aderenza dei pazienti. Infatti, rispetto ai pazienti del passato quelli di oggi partono in condizioni migliori - chiarisce Manzillo -. Le persone che noi osserviamo come naive (coloro che non ha mai assunto una determinata molecola, ndr) hanno una situazione immunologica di base sicuramente discreta, il che permette loro di rispondere meglio alla terapia farmacologica ma che non deve indurli ad abbassare la guardia”, conclude Manzillo. di Adnkronos   17-07-2024 - 10:30 Link copiato Commenti Leggi la Netiquette

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