Sesso, morte e AIDS. C’è un filo sottile che lega queste realtà apparentemente così lontane. Banalmente si potrebbe pensare ad un rapporto causa-effetto, in quanto è risaputo che il sesso non sicuro può portare all’infezione da HIV che a sua volta, più o meno direttamente, conduce inesorabilmente alla morte.
In realtà ciò che accomuna questi termini è che per molto tempo sono stati, e in alcuni casi ancora lo sono,  “argomenti tabù” per eccellenza; proprio per questo, il binomio AIDS-pregiudizi, ha contribuito a rendere ancor più tragica una malattia già di per sé temibile.

Cos’è l’AIDS?

AIDS è l’acronimo di Aquired ImmunoDeficiency Sindrome, una patologia diagnosticata per la prima volta negli Stati Uniti nell’estate del 1981.
La malattia è caratterizzata da grave compromissione del sistema immunitario, con conseguenti infezioni opportunistiche o tumori a carico di vari organi e sistemi.
Il virus responsabile (HIV, Human Immunodeficiency Virus)  è in grado di inserire il proprio RNA dentro il DNA della cellula che lo ospita, ovvero il linfocita umano.
I sintomi iniziali, successivi al momento dell’infezione, sono purtroppo molto simili a quelli tipici della maggior parte delle malattie virali (febbre, mal di gola, dolori muscolari, ingrossamento dei linfonodi, nausea). A questi fa seguito una fase di latenza clinica durante la quale l’infezione progredisce, con conseguente distruzione delle difese immunitarie del soggetto.

Le innovazioni terapeutiche

Negli ultimi anni il trattamento di coloro che si sono infettati è andato incontro a progressivi miglioramenti. Sia pure con i limiti legati alla complessità dei cicli di cura (alto numero di compresse da assumere giornalieramente, ed elevata tossicità delle molecole), le nuove combinazioni di farmaci dotati di azione antiretrovirale sono in grado di rallentare in modo significativo la progressione dell’infezione da HIV e di ridurre drasticamente la mortalità dei soggetti malati.                               

Da qualche giorno, grazie ad una scoperta tutta italiana, è possibile immaginare una cura definitiva che non si limiti esclusivamente a rallentare il decorso nella malattia.                                                                                                 Infatti i ricercatori dell’Icgeb, guidati dal direttore del Centro di medicina molecolare Mauro Giacca (l’Icgeb è un’organizzazione internazionale delle Nazioni Unite che opera dal 1987 a Trieste), sono riusciti a fotografare la struttura del nucleo dei linfociti scoprendo in tal modo dove il virus dell’HIV si nasconde e in che modo riesca ad eclissarsi una volta penetratovi.
L’importanza di questa scoperta risiede nel fatto che, fino ad ora, nessuno è mai riuscito a capire come mai il virus colpisca solo determinati geni (quelli trascrizionalmente attivi), all’interno dei quali si integra e si nasconde, rendendosi scarsamente sensibile all’eradicazione farmacologica. Da oggi questo potrebbe non essere più un problema.
Gli studiosi hanno anche dimostrato che la presenza di due proteine (NUP153 e LEDGF/p75) è fondamentale perché il virus riesca ad inserirsi nella cellula e sono riusciti ad individuare la “tana” dove l’HIV si nasconde fino al momento in cui riemerge e dà inizio alla sua attività di replicazione all’interno delle cellule del sistema immunitario.

Rappresentazione della localizzazione del virus all'interno del nucleo delle cellule umane
Rappresentazione della localizzazione del virus all’interno del nucleo delle cellule umane

Nell’articolo pubblicato su “Nature” i ricercatori hanno dimostrato che l’integrazione dell’HIV avviene nel guscio esterno del nucleo, in stretta corrispondenza del poro nucleare, la struttura che segna il passaggio tra il nucleo e il citoplasma della cellula. Fotografando la struttura del linfocita T, il cui ruolo è fondamentale nell’immunità cellulo-mediata, gli scienziati hanno avuto la possibilità di costruire una vera e propria mappa topografica della cellula che, da oggi in poi, sarà il punto di partenza nella terapia antivirale.

La centralità di questa scoperta è stata chiaramente espressa anche dal responsabile del progetto, il professore Mauro Giacca:

“È come quando entriamo in una sala cinematografica al buio, i posti più comodi magari sono quelli più lontani, ma quelli più facili da raggiungere sono vicini alla porta d’ingresso, ed è li che ci sediamo. Ma inserendosi nei geni vicino alla porta d’ingresso, ecco che la probabilità che il virus si nasconda ai farmaci diventa più alta: questo è il motivo per cui oggi riusciamo a rallentare la progressione verso l’Aids, ma non riusciamo a eliminare l’infezione.” – prof. Mauro Giacca

Queste parole sottolineano il motivo per cui l’efficacia dei farmaci in commercio si ferma all’ingresso della cellula, avendo dunque solo la possibilità di rallentare l’evoluzione della malattia, ma non di debellarla. Non è un caso se dall’inizio degli anni ’80, quando il virus dell’HIV fu scoperto, quasi 80 milioni di persone siano state infettate senza che nessuno sia riuscito a guarire completamente.

L’importanza della prevenzione

La ricerca dell’Icgeb, di cui l’Italia deve andare fiera, spiana la strada allo sviluppo di farmaci che possano essere più efficaci nella cura dell’AIDS. Vale la pensa evidenziare che questa rinnovata speranza per una futura cura della malattia non deve in alcun modo sostituirsi ai messaggi atti a sottolineare l’importanza della prevenzione.
Dopo vent’anni si può affermare con certezza che non esiste possibilità di contagio attraverso contatti casuali: i reali mezzi di trasmissione (sangue, secrezioni o liquidi sessuali infetti) possono e devono poter essere controllati in maniera responsabile e la sensibilizzazione in tal senso deve procedere sempre di pari passo con la ricerca.

Alessandro Savo Sardaro
Redazione | Università Degli Studi di Roma Tor Vergata VI anno corso di laurea in Medicina e Chirurgia “Choose a job that you love and you will never have to work a day in your life”.

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