freedomhealth - private medical service - sexual health services - aesthetic & cosmetic health

Freedomhealth has launched its online medical service Freedomhealthonline.co.uk.

Freedomhealthonline allows patients to order a range of treatments online for a large range of health issues, including erectile dysfunction treatments, anti-malaria tablets, the morning after pill and emergency contraception without having to see a doctor face to face. The new site offer safe, secure, convenient online medical service.

Uniquely, Freedomhealthonline is a completely transparent site with all staff and doctors easily identifiable at any stage and available for email, telephone or face-to-face consultations as desired. No other online clinic provides this clear accountability.

To make an order patients complete a medical assessment and make a pre-payment. The assessment is then reviewed by a Freedomhealthonline doctor and if the patient is suitable for the treatment it is posted out by first class recorded delivery.

Current online medical services include provision of anti-malaria pills, asthma inhalers, contraceptive pills, the morning after pill, medicines to treat male erectile dysfunction and male hair loss. Treatments for sexually transmitted infections are also available including treatment for chlamydia and genital herpes. A telephone consultation service allows patients to opt for telephone advice with a doctor of their choice and they also have the option to book to see one of the doctors in the Central London Freedomhealth Clinic, a Care Quality Commission registered facility.

Freedomhealthonline does not replace the traditional face to face consultations and patients are welcome to visit us at our clinic. But not all patients have the time to come and see us and some find discussing their problems embarrassing. Freedomhealthonline will make it even easier for patients to manage their health needs. What is unique about the service compared to other online doctor services is that all the doctors working on our online service are practising GP’s and full time doctors working at our Harley Street clinic. There are many websites that offer a similar online doctor service but few if any can actually offer to see their patients in a clinic. By using Freedomhealthonline patients are guaranteed that they have been assessed by a real doctor and that any medicine supplied is genuine.

All Freedomhealthonline doctors are fully registered with a licence to practise from the GMC and all are very easily identifiable. Freedomhealthonline uses a fully registered UK pharmacy to distribute genuine, branded medications.

“Patients increasingly want different ways of managing their health needs. At Freedomhealth there is the option of a GP clinic and an online doctor service. This suits patients who want to self-manage some health problems and see us face to face for others. We provide affordable and safe online medicines,” says Dr Alex Vass, GP.

To view Freedomhealthonline please go to: http://www.freedomhealthonline.co.uk/

Freedomhealth  is run by experienced general practitioners and doctors who offer a range of high quality services including:

•     Private Doctor Consultations
•     Health Screening
•     Telephone Consultations
•     Travel Clinic
•     Sexual Health Screening
•     Cosmetic Services
•     Online Medical Service

The medicines you take with you when travelling abroad will of course depend on where you are going, how long for, what type of activities you will be doing and your general health before you go.

Even when travelling to countries with high standards of healthcare and pharmacy, it is best to carry some basic medicines with you. If you need them in an emergency, you can’t always guarantee you will find a local pharmacy near your hotel or in the middle of the jungle!

It is a good idea to take blister packs of paracetamol or ibuprofen to treat mild headaches, toothache, muscular or menstrual pain. Antiseptic wipes are useful for treating cuts and grazes to avoid infection, and it might be worth taking a basic first aid kit with you, complete with bandages and plasters.

If you are travelling to a hot country, take sun cream and insect repellent. If insect bites particularly affect you, and you know you might need adrenaline, take your epipen or equivalent.

Travelling can cause problems with constipation or diarrhoea. It is worth taking both laxatives and diarrhoea treatments, including rehydration solutions, which can easily be bought at your local chemist and can be used to alleviate short-term problems. Antacid is also a useful thing to carry if you suffer from heartburn or stomach acid after eating particularly hot or unusual foods.

You should always remember to take medicines and equipment for pre-existing conditions with you. Speak to your doctor in advance of your trip and ask them to prescribe your regular medication for the time you are abroad. They are allowed to prescribe you three months’ supply of your medicine for travel within Europe.

If you are carrying needles, syringes or prescription-only medicine it is a good idea to ask your doctor to provide you with a statement explaining your condition and treatment, particularly if you are going further afield than Europe where there may be tough restrictions on what you can take in to the country. Check before you leave what you are allowed to take with you otherwise you could face problems when you reach customs.

You may find it helpful to have the statement from your doctor translated if you are travelling to a country where English is not the first language. Make sure the people you are travelling with are aware of your condition and how it should be treated in an emergency.

A European Alliance for Access to Safe Medicines report, The Counterfeiting Superhighway has revealed that a remarkable 62 % of all medications ordered by unsuspecting patients worldwide are either completely fake or simply substandard.

The web is full of cheap offers for prescription item drugs which often have never seen the inside of a pharmaceutical company production line or a pharmacy. Over 95% of the pharmacies operating online were said to be fake and operating without a pharmacist or qualified dispenser and without a licence.

The report does make fascinating reading and shows both how vulnerable people will quite easily part with hard earned cash and hand over their bank details to totally unscrupulous criminals who then either supply them with fake medications such as anti-HIV medications or erectile dysfunction drugs or just keep the money and rely on the patient’s embarrassment to prevent them going to police or other authorities.

Ian Banks, President of the European Men’s Health Forum makes the point in an introduction that whilst seeking medications for embarrassing illnesses or conditions is convenient and spares peoples blushes, it does deprive people both of the opportunity to discuss health issues and underlying causes. More men than women will be ensnared by the counterfeit medication pharmacies.

Fake medicines often don’t contain any active ingredient at all and so may at best be a waste of money or at worst may not treat a condition that requires medications. Examples would be fake statin medicines. These are probably amongst the biggest group of prescribed medications worldwide and patients are often anxious to get them as cheaply as possible, hence resorting to the web. Fake medicines may also contain too little or too much of an active ingredient and so again may compromise health.

Some have suggested that the issue surrounding counterfeit medications is one invented by the pharmaceutical industry to protect profits. I can see the reason for that thought process but in reality, most of the online pharmacies offering cheap or abundant supplies of sleeping tablets, anti-depressants, anti-HIV medications and erectile medicines are just crooked sites fishing for bank and credit card details and maybe supplying something in return.

The medications most frequently peddled by counterfeiters are those which are generally hard to get such as anabolic steroids, human growth hormone and sleeping tablets and so have a huge demand and also those which have less of a demand but a high cost, such as the erectile dysfunction or impotence medications. Remember that males are much more likely to buy medicines online than their more savvy female counterparts.

The size of the counterfeit medicine market is huge with around 500,000 false medicinal products being seized in the EU in 2005 and this having increased to over 2.7 million fake medicines in 2006 – a five fold increase in just one year. The monetary value of the false medication market globally is thought to be $55 billion dollars in 2010. A fantastically huge sum.

Legitimate and legal online pharmacies do exist and there are many safe operators in the EU. Freedomhealth provides medical services to a number of safe, UK registered and regulated pharmacies in the UK and is shortly opening its own branded online doctor service.

The Counterfeiting Superhighway report notes “When used
appropriately, legitimate online pharmacies offer a convenient,
discreet and fast delivery service for medicines and healthcare
products. Prices are typically lower compared with high street
pharmacists and items are delivered direct to your door.
Registered online pharmacies can provide convenient access
to healthcare products and advice for people who are perhaps
elderly, disabled or who live in remote areas or work long/
unsociable hours. They offer significant advantages for people who
cannot easily travel to a medical centre or high street pharmacy.
Online pharmacies will ask you for registration information
and credit card details for payment. Where prescription-only
medicines are requested, buyers must also provide an authorised
prescription, usually by post, before the products can be
dispatched. Without this, it is illegal for any medicines supplier to
sell or provide prescription medicines”

Unfortunately, legitimate online services may be drowned out by the volume of fake sites.

The report ends with some helpful advice to consumers intending to buy medications online.

• Don’t buy from medicine or online pharmacy websites that offer to sell you medications without a prescription
• Don’t buy from pharmacies that do not have a registered pharmacist available to answer questions or where you can’t see a clear route to contact and discuss issues with the pharmacy
• Don’t buy from pharmacies that offer to sell in bulk or discount offers or summer specials
• If the service offers an online consultation then be careful and validate that the pharmacy is real and that the doctors are real. Freedomhealth offers an online consultation service via its different provider pharmacies. With each of these agencies you know that Freedomhealth has real UK GMC doctors controlling the review and issue of medications and that there are real UK registered pharmacists processing the orders and issuing genuine, branded, original medications
• Only buy from services which are regulated appropriately.

Other safety advice is to check the doctors registration on the General Medical Council website and that the service is registered with the Care Quality Commission. Check the pharmacy is registered with the General Pharmaceutical Council. Legitimate online clinics and pharmacies are transparent and will happily provide and supply any regulatory information you may require.
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Saturday GUM and STD / HIV clinics

In a paper in the Journal of STD and AIDS 2010; 21: 273-276, Challenor and Warwick assessed the acceptability and usage of weekend GUM and STD clinics in response to increasing demand and pressure to see mor epatients.

In perhaps an unsurprising finding they discovered that the Saturday GUM clinics were popular and more so than Sunday clinics. This is in keeping with our experience with Saturday GUM Clinics at our London Freedomhealth Clinic. Freedomhealth opens every Saturday between 10.30 am and 3.30 pm and the clinics typically are booked in advance with many “walk-in’s” – ie patients without prior booked appointments. Reasons offered are that many of our patients find it difficult to get away from work in the week; attending NHS clinics tends to result in the waste of a good part of the day and patients are able to choose which of our doctors they can see.

Challoner and Warwick’s review showed that around 30% of patientswere likley or very likley to use a Saturday NHS GUM Clinic service. They also found that Saturday patients are more likely to attend with symptoms of a http://www.freedomhealth.co.uk/sexual-health/std-sti-test-and-testing-clinic-london/175/. Interestingly many patients attending the Saturday GUM NHS clinic were too embarrassed to reveal to admin staff that they had symptoms.

Our patients on the other hand tend to be very informative about their symptoms and conditions before they arrive at our private GUM clinic.

Should gay men be screened for anal cancer?

Cases of anal cancer among gay men who are HIV positive have been on the rise since the advent of antiretroviral treatment for those living with the virus.

Consequently questions are now being asked about whether men who have sex with men should be routinely screened for anal cancer using anal cytology (taking cell samples from the area) and high resolution anoscopy (a tube used to see the lining of the anus).

In an article published in Wolters Kluwer Health journal Dr Paul Fox examines the current evidence and opinion on routine anal cancer screening. Dr Fox is a Consultant Physician at the ChelseFreedomhealth Clinic in London a and Westminster Hospital and also where he runs a private High Resolution Anoscopy Clinic for anal cancer screening.

Current UK guidelines do not recommend routine anal cancer screening and guidelines from outside the UK vary. For example in New York routine anal cytology is recommend for gay men, whereas leading groups in other states including Texas and California say that there is not yet enough research to form any guidelines.

There are a number of reasons why routine anal screening programmes have not been rolled out. The cost, both of setting up and maintaining the programme, is just one of the factors. Balancing the need for screening with any patient anxiety is another factor as well as concerns over the efficacy of screening.

The sensitivity of anal cytology is regarded as poor and so is used in conjunction with high resolution anoscopy, where medical professionals will look for the precursor lesion to anal cancer known as a high grade squamos intraepithelial lesion (HSIL).

A number of studies have been carried out to try and assess how great the risk of anal cancer is to gay men in a bid to identify groups that could benefit from routine anal cancer screening.

Dr Fox makes some criticism of the small number of studies for the way in which patients were recruited; many were not randomly selected meaning there was a potential selection bias.

However Dr Fox highlighted two recent studies which he was sure eliminated selection bias, one by randomly selecting patients and another by using the entire population of an HIV clinic.

The first study screened the 516 patients of an HIV clinic in Paris. It was found that 473 had HSIL, and that men who had sex with men were more than twice as likely to have HPV lesions – which can be potentially cancerous – than heterosexual men or women.

A second study looked at HIV patients on antiretroviral treatment from different demographic groups, evenly divided between MSM, heterosexual men and women. It found what Dr Fox described as “surprisingly little difference” between the groups in terms of the number of patients with HSIL. Around 5% of people in each group had an HSIL – the anal cancer precursor lesion.

The figure matched data from the days before antiretrovirals were available, leading Dr Fox to conclude that there was a possibility that the rising incidence of anal cancer in HIV-positive patients treated with anti-retroviral therapy is due to patients living longer, which gives greater rise to the cancers occurring.

Dr Fox also concluded that patients on antiretroviral treatment must therefore be at greater risk of their HSIL making a malignant transformation into anal cancer.

There were also concerns that treatment was less effective for HIV patients compared to HIV negative people. Dr Fox looked at a number of studies carried out on the treatment of HSIL and anal cancer.

A study by Goldstone et al showed that 65% of HIV positive men who received infrared coagulation treatment treatment for HSIL had new or persistent lesions after a 10 month follow-up, compared to 50% of patients who were HIV negative. A further study, which differed in its methodology by performing a repeat biopsy of the treatment site at 6 months post-treatment found only 10% of HIV positive patients were disease free.

A study on the outcome of two different types of treatment for HIV positive men with HSIL has provisionally shown little difference. It looked at patients who were given a single infrared coagulation treatment and those who applied trichloroacetic acid once monthly for four months. There was an individual clearance of 68% with individual lesions with IRC and 87% in the group treated with trichloroacetic acid.

A further study involved a placebo controlled study of 53 HIV patients using a self-applied imiquimod cream. In the patients using the cream the response rate was 39% compared to those using the placebo cream.

In a further study where participants were offered open-label imiquimod the response rate was 40% with half of those patients having a complete and sustained resolution of their lesions.

It was noted that the benefit of these treatments is that the lesions disappear and although some recur in different locations it is thought that lesions that have not been static for some years will carry only a low risk of malignant transformation.
According to the article it is therefore reasonable to suppose that treatment of HSIL will reduce the likelihood of anal cancer, but this has not yet been proven.

Dr Fox also concluded that anal cytology is a validated means of detecting anal cancer but is best restricted to selected patients.

He recommends that clinics carry out physical, digital examination of the anus to look for abnormalities and that this becomes the standard at HIV clinics.

A study in San Francisco highlights the important of digital examination. The cases of 21 patients who had developed anal cancer were examined and it was found that 19 had presented with palpable mass, an induration or ulcer. The implication was that physical examination could have picked up these lesions at an early stage.

Patients should also be encouraged to self-examine with Dr Fox saying it may be “just as effective as a cytology based approach”.

He says the clinics must play an important role in encouraging patients to self-examine and helping them learn how to carry it out properly. The report suggests clinicians carry out the initial examination to prevent patients becoming concerned by lumps that are either benign or part of their normal anatomy.

Cost concerns over shingles vaccine

Earlier this year government advisors recommended that a vaccine against shingles be given to Brits aged between 70 and 79, but raised concerns over its cost. Now, as research shows just 10% of eligible patients in America have received the vaccine because of its high price, is there really a hope for Britain’s elderly?

Shingles is the common name for herpes zoster which is caused by the reactivation of the virus which causes chicken pox and then lies dormant in our body.
The virus is called the varicella-zoster virus and is reactivated in around a third of people who have had chicken pox, causing shingles – which is a localised rash commonly with blisters. Unlike chicken pox, shingles is not contagious.

People of any age can develop shingles but it commonly occurs in people aged over 50, this is because of the decline in immunity as people age. For this reason people with suppressed immune systems are also susceptible to shingles, according to Kimberlin and Whitley writing in the New England Journal of Medicine.

They report that a patient over 60 years old is 8 to 10 more times more likely to develop shingles than a younger patient and that shingles will have developed in up to half of people who are 85 years old.

One of the most serious complications of shingles is a condition known as postherpetic neuralgia, a persistent pain which remains in the area of the rash after the rash has gone. It is caused by the virus damaging a nerve and can lead to pain, itchiness, numbness which can last for months or years.

Estimates suggest that around 250,000 people in the UK get shingles every year, and almost 100,000 of them develop postherpetic neuralgia. Patient.co.uk reports that 1 in 4 of those with shingles develops postherpetic neuralgia that lasts more than 30 days.

As Nigel Scott from the Shingles Support Society told the BBC,: “Shingles and postherpetic pain, can make people’s final years a complete misery’.
So you would think there would be widespread relief about the Joint Committee on Vaccination and Immunisation recommending to the British government this January that a vaccine against shingles be given to those aged between 70 and 79.
The vaccine works as a preventative measure given before the reactivation of the varicella-zoster virus. It has been used in America for over four years, where it is available for everybody over 60 years of age.

Just one dose of the vaccine is needed. The vaccine contains the live varicella virus which enables the body to develop enough immunity against it, giving the patient a new ‘immunologic threshold’ above that at which the patient is at risk for shingles.

Kimberlin and Whitley report a study found that the vaccine reduced the likelihood of developing shingles by over 50%. The evaluation was based upon two groups totally around 40,000 people, one who had received the vaccine and another who had received a placebo. The study also found that the incidence of postherpetic neuralgia was 67% lower among those who had received the vaccine.

The study found that around 17 people would need to be vaccinated to prevent one case of shingles and 31 would need to be vaccinated to prevent one case of postherpetic neuralgia.

Side effects appear to be minimal with rashes at the injection site and skin redness being reported. However, the study was carried out less than a year after the shingles vaccine became available to Americans and so it was difficult to study the potential risk of rare adverse effects.

The biggest side effect seems to be the cost. Writing for the New York Times in June this year, Pauline Chen reports that in the two years since the shingles vaccine became available, fewer than 10 percent of all eligible patients have received it.
This is because the shingles vaccine typically costs between $160 and $195 dollars, around 10 times more than other commonly prescribed adult vaccines. Chen reports that even patients with health insurance plans are not having the vaccine because of complicated reimbursement methods relating to it.

The article also describes how American doctors have tried to help patients obtain their vaccines more cheaply. Some have sent their patients to cheap pharmacies to buy the vaccine and then return to the surgery to be injected, or to go to pharmacies which offer immunisations to have the vaccine administered there.
However, Chen reports that the hassles of these methods put patients off.
Now it looks like the cost of the vaccine may prove to be a hurdle with the roll-out of the vaccination programme by the NHS in the UK.

Vaccination against shingles would just be available to people in the UK between the ages of 70 and 79, according to the BBC. This is despite the aforementioned study finding that the vaccine was more effective in preventing shingles among persons aged 60 to 69, than those aged 70 or over.

It also contrasts with the situation in the US, where all over 60s are recommended to be vaccinated against shingles.In January the Department of Health told the BBC the programme was dependent on a “fair price” but that they was confident this could be achieved, given that four million doses would be required.

They also revealed that the programme should start before the end of the year to achieve maximum effectiveness.

Genital Herpes (HSV2) and HIV disease: Why does it matter?

There is good evidence from population studies of people infected with both HIV1 and also HSV2 that infection with Herpes Simplex 2 virus will both increase the amount of HIV1 which is shed in gental secretions and also it increases the rate at which HIV 1 is transmitted.

Treatment designed to suppress Herpes simplex 2 (HSV2) is established to reduce the amount of HIV1 RNA in blood and also genital secretions such as semen and vaginal secretions.

The impact of co-infection (having infection with HIV and HSV2) of HIV1 and HSV2 is very significant indeed with HSV2 and HIV1 co-infected individuals having very much more HIV1 RNA (ie the infectiouness of the individual is increased) in their genital secretions and also in their blood. This obviously means that their potential for spreading HIV either through asymptomatic HSV shedding or symptomatic HSV2 lesions is greatly increased. In addition, treatment for the HSV2 part of the co-infection has no effect on the HIV1 directly but does reduce the HIV1 viral load.
HIV viral load increases are associated with an accelerated course towards the development of AIDS defining diagnoses (AIDS is not the same as being HIV positive). The way anti HSV2 medications reduce HIV1 viral load is thought to be through partly interupting the “HIV inducing effect” of HSV2.

Unfortunately, we also know that people with HSV2 genital lesions are much more likely to acquire HIV1 from an HIV infected individual – by a factor of up to six times more likely.

Up to 60% of people living in the “West” with HIV have Herpes Simplex 2 (HSV2) infections whereas in Sub-Saharan Africa the figure is thought to be up to 90%.
A study by Nagot and others published in the NEJM (Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med 2007;356:790-9) looked at HIV1 and HSV2 co-infected populations in Sub-Saharan Africa and treated trial subjects with valaciclovir, an anti-HSV2 drug.

HIV1 is shed from HSV2 lesions and most of the shedding (85%) occurs without the actual physical appearance of HSV2 genital ulcers.

The effects were to markedly reduce the re-occurence of HSV2 lesions, and to markedly reduce the amount of HIV1 in both blood and also genital secretions.

The significance of this is that reducing the HIV1 viral load in the genital tract by treating the additional HSV2 infection may reduce the transmissibility of HIV1 infections (and probably HIV2 although this was not within the studied populations).

A further possible scenario is that people with HSV2 but not HIV will be at theoretically reduced risk of HIV acquisition if they suppress the appearance of HSV2 lesions by long term suppressive treatments such as aciclovir or valaciclovir. Aciclovir has the great advantage of being very cheap and very well tolerated.

Freedomhealth is launching a brand new STD/STI and HIV / Hepatitis B and Hepatitis C testing service across Europe. Patients can text the code for the STD or HIV test of their choice to a dedicated number and an HIV / Hepatitis B / Hepatitis C /STD /STI testing kit will be sent to them by post (arriving the next working day if ordered by 5.00 pm).

Each test is performed by the Doctors Laboratory. the biggest private laboratory in the UK and part of the Sonic Group which is a global provider of diagnostic services. The Doctors Laboratory is a major and sophisticated testing facility.

Freedomhealth works closely with The Doctors Laboratory and also in partnership with ChemistDirect to provide a comprehensive range of Health Solutions.

Freedomhealth is registered with the Care Quality Commission, has a permanent staff of dedicated, very experienced and well trained doctors and also operates a walk-in or appointment service from very comfortable, smart and clean premises at 60 Harley Street London W1G 7HA. If you’d rather visit us then please call us on +44 (0)20 6371600.

We also offer telephone consultations for one to one discussion of your individual circumstances.

This innovative new system is simple and very easy to use.

Decide which test seems the most appropriate for you and then text the special code to 88020 if you live in the UK or +447950080232 if you live in Western Europe.

You will then receive a set of very simple questions and some instructions. The test results will be returned to Freedomhealth Limited and all results will be individually checked by one of our doctors.

The tests currently available are as follows:-

FHPATH1 – this is a very sophisticated combined urine test which will correctly identify genital infection with chlamydia, gonorrhoea, herpes 1 and 2, mycoplasma, ureaplasma, trichomonas, and gardnerella all in one simple test. The test costs £180 and the fee is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH1 to 88020.

FHPATH2 – an important urine test for chlamydia alone. The test costs £70 and the fee is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH2 to 88020

FHPATH3 - this is a combined test looking for chlamydia and gonorrhoea. The test costs £85 and is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH3 to 88020.

FHPATH4 – this is a state of the art HIV DUO BLOOD test kit. The HIV DUO test combines a test looking for HIV 1 and 2 antibodies and also p24 antigen which allows for very early detection of HIV infection. This is an excellent test and very accurate indeed after just 28 days after possible exposure. The test costs £75 and is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH4 to 88020

FHPATH5 – a superb Early Detection Screen for very early HIV 1 and HIV 2, Hepatitis B and Hepatitis C – testing from as early as 7 days post possible exposure to HIV. This test is superior to the HIV DUO and can be done much earlier. In terms of HIV it detects RNA which is the key viral structure. The test costs £192 and this is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. The test takes 5 working days to be processed from the date of receipt. To obtain this test kit text FHPATH5 to 88020

All of these tests are available by simply texting the test code number to the 88020 (or +447950080232 if you live in Western Europe and outside the UK) and answering the simple questions.

You have the option if you live within the London M25 area of requesting a nurse to visit you to collect the blood from you. You can do this by calling us on 020 7637 1600 Monday to Friday 8.30 am to 6.30 pm or Saturday 10.30 am to 3.30 pm and asking for the Freedomhealth Visiting Nurse service. This service will cost a further flat fee of £85 which covers the cost of dispatching the nurse to you, collecting the blood and returning to the laboratory with your samples.

Telephone consultations are available with one of our doctors through the week and into Saturday’s. They are pre-paid at the time of booking and we charge £55 for a twenty minute consultation.

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¿Cuál es la mejor prueba de detección del VIH?

La mejor prueba para detectar el VIH es aquella que proporcione un resultado exacto y tranquilizador en el marco de tiempo que más le convenga. Cada persona va a tener una “mejor prueba del VIH” diferente porque las circunstancias serán ligeramente diferentes. Los elementos principales a considerar serían en primer lugar, el momento en el cual uno haya estado posiblemente expuesto al virus VIH y en segundo lugar lo desesperadamente que uno necesite saber la respuesta. El momento de exposición es importante porque nos permite calcular el período ventana del VIH, que es el tiempo desde la infección por el VIH hasta el momento de la posible detección.

Existe una gran confusión respecto a las pruebas del VIH lo que se debe principalmente a los enormes avances en nuestro conocimiento sobre el VIH en el tiempo que ha transcurrido desde que comenzó la epidemia y el progreso de la tecnología para el desarrollo de las distintas pruebas. En consecuencia la respuesta a cuál es la mejor prueba de detección del VIH depende en gran medida de las circunstancias individuales.

Ahora tenemos métodos que nos permiten en realidad identificar la infección por VIH muy pronto. Esto es importante por todo tipo de razones, y no es menos importante el hecho de que así sabemos que el período más importante para la transmisión del VIH a otras personas es en los primeros meses después de la infección, cuando la cantidad de virus en el torrente sanguíneo, el semen o los fluidos vaginales de la persona infectada, es probablemente que sea muy alto. La cantidad de virus VIH en un fluido corporal se conoce como carga viral del VIH y en las primeras etapas es probable que haya muchos cientos de miles o millones de copias del virus en cada mililitro de sangre u otro fluido.

A medida que avanza la infección y el cuerpo de la persona recién infectada comienza a tomar control de la nueva infección por el VIH, la cantidad de virus disminuye y así se convierte en esa persona, pensamos, mucho menos infecciosa. Así, por ejemplo, si yo fuera hoy mismo a convertirme en VIH positivo, entonces en alrededor de aproximadamente 2 semanas mi carga viral – la cantidad de virus en cada ml de sangre o semen – aumentaría rápidamente alcanzando varios millones de copias . En este caso yo sería muy infeccioso para las personas con las que tuviera relaciones sexuales.

La detección temprana de nuevos casos de infección de personas VIH positivas nos permite tener oportunidades para poder influir de una forma positiva en un mejor pronóstico de la enfermedad y en una reducción en la transmisión. Sabemos por estudios que la mayoría de las personas que saben que son VIH positivas estarían dispuestas a tratar de evitar la transmisión del VIH a otras personas.

Entonces, ¿cuál es la mejor prueba de detección del VIH?

- Las pruebas para detectar el VIH una semana después de la exposición

El diagnóstico preliminar del VIH y de la enfermedad de la hepatitis C es ahora posible sólamente 7 días tras la exposición a los virus. Este período de tiempo tan corto no estaba disponible en el pasado, pero la utilización novedosa de una tecnología estándar de rutina nos ha facilitado el diagnóstico temprano. La técnica ha tenido la mayoría de sus aplicaciones hasta ahora en la detección del suministro de sangre humana de donantes de sangre y ha reducido muy considerablemente el número de casos con contaminación inadvertida con el VIH y el virus de la hepatitis C. La técnica también se emplea en la donación de órganos, los cuales para ser donados son examinados con la misma técnica de detección del VIH-1, VIH-2, hepatitis C y virus de la hepatitis B.

Un estrecha colaboración con The Doctors Laboratory (un laboratorio de referencia mundial en Londres), nos ha permitido aplicar esta técnica de detección en sangre, para iniciar el proceso de diagnóstico de las enfermedades mencionadas.

La técnica de diagnóstico ultra-rápido utiliza un sistema completamente automatizado realizado por Roche y el método de ensayo
utiliza la reacción en cadena de la polimerasa (PCR) o NAT (Amplificación de los Acidos Nucleicos) siendo posible detectar cantidades minúsculas de material genético del virus (y la técnica puede aplicarse también a las bacterias).

El proceso funciona de la siguiente manera. Tomamos una cantidad de sangre suficiente para ejecutar las tres pruebas NAT para el VIH-1 y VIH-2, virus de la hepatitis C y el virus de la hepatitis B. También podemos incluir la sífilis IgG e IgM dentro de esa pantalla. La prueba se realiza utilizando la plataforma de Roche y se ejecuta con la técnica de “sample in, results out”, lo que reduce las posibilidades de contaminación del producto, etc a cero. En caso de una muestra positiva, toda la muestra se analiza a continuación para identificar exactamente el virus que ha producido el resultado positivo y más pruebas adicionales específicas de confirmación se llevan a cabo.

El resultado es de una alta sensibilidad,y los métodos de detección son de alta precisión. El tiempo de respuesta es rápido, necesitando un máximo de 4 ó 5 días.

– Prueba de los anticuerpos VIH 1 y 2 y del antígeno p24 (VIH DUO o VIH Combi)

Esta prueba del VIH está aprobada en la Unión Europea para su uso 28 días después de una posible exposición. Es, probablemente, mucho mejor que esto y es probable que pueda identificar a la mayoría de las personas VIH positivas infectadas entre los 14 y 21 días. Esta prueba del VIH se conoce como de cuarta generación . Ciertamente en nuestra clínica hemos tenido muchos nuevos diagnósticos de pacientes positivos con esta prueba combinada del VIH DUO tras este periodo de tiempo mencionado de 14 a 21 días.

La prueba del VIH DUO se basa en el principio de que cuando el VIH primero se establece en el cuerpo, empieza a replicarse rápidamente y casi como un subproducto de esta replicación una proteína central – el antígeno p24 del VIH – se produce en grandes cantidades alrededor de los 10 días después de la primera infección y durante el tiempo en que los anticuerpos del VIH se están formando. El antígeno p24 entonces estaría a un nivel muy alto durante los primeros meses después de la infección, seguido de una disminución posterior de acuerdo con la disminución de la carga viral del VIH. Nunca desaparece por completo y se podrá detectar a diferentes niveles durante el curso de la enfermedad.

Así que en general, el antígeno p24 se forma un poco antes de que los anticuerpos aparezcan, lo que nos permite cerrar la brecha entre la infección y el tiempo de detección – el período ventana del VIH. Conforme pasa el tiempo, la mayoría de las personas VIH positivas forman anticuerpos contra el VIH 1 ó 2 después de 28 días. Buscando entonces en combinación tanto al antígeno p24 como a los anticuerpos del VIH 1 y 2 permitiría la detección del VIH mucho antes que si buscamos sólamente los anticuerpos contra el VIH.

- Prueba de anticuerpos VIH 1 y 2

En torno a esta prueba es donde se centra la mayor confusión. Cuando la epidemia comenzó a principios de los años ochenta, nuestros métodos y dispositivos de análisis eran relativamente pobres y con frecuencia producían resultados falsos. Esto fue en gran parte debido a que los investigadores estaban tratando de encontrar en primer lugar, la causa y luego una prueba de detección de una enfermedad nueva y virulenta.

Recuerdo muy bien aquellos primeros días llenos de pánico. Los resultados falsos – tanto los falsos positivos com los falsos negativos nos condujeron en ese momento a tener una gran cautela en la interpretación de los resultados de las pruebas del VIH. Con el tiempo, nuestro mayor y mejor conocimiento de la enfermedad, junto con los avances en los métodos de control han contribuido enormemente en la mejora de las pruebas de detección.

Hemos pasado de las pruebas rudimentarias a principios de los años ochenta, a las pruebas del VIH de tercera y cuarta generación en 2010. Las pruebas de anticuerpos VIH 1 y 2 en uso en el Reino Unido y resto de Europa Occidental son de tercera o cuarta generación. Las modernas pruebas de tercera generación identifican a más del 99% de las personas VIH positivas infectadas 6 semanas después de la exposición a pesar de que tienen licencia sólamente para su uso después de 12 semanas tras una posible exposición.

La mejor prueba del VIH siempre va a ser la que se adapte al periodo de tiempo específico de posible exposición al virus, así como también sería necesario saber el nivel de ansiedad o preocupación en el paciente. Siempre hemos de recordar que si Usted tiene una exposición de alto riesgo, como el sexo sin protección con alguien que se sabe que es VIH positivo, o una ruptura de condón con alguien que se sabe que es VIH positivo, entonces no se debe esperar a hacer la prueba, sino que se debe consultar un médico lo antes posible para considerar la Profilaxis Post Exposición (PEP) al VIH, que se debe comenzar idóneamente antes de 36 a 72 horas después del incidente.