Despite the progress made in recent years in the fight against AIDS, there is no doubt that it continues to be one of the most serious public health problems in the world . In Spain about 500 people a year continue to die of AIDS; and many because they are not diagnosed. Left untreated, HIV becomes a potentially very serious disease.
According to data from the World Health Organization, in 2015 there were almost 37 million people infected with HIV, and more than 2 million were due to new infections.
What is the specific AIDS situation? What challenges do we face in the fight against HIV infection?
On the occasion of World AIDS Day, 5 professionals meet to share the approaches around prevention, treatment and future prospects for HIV patients in a round table moderated by the editor-in-chief of Wecare – u Santiago Quiroga and Enrique Coperías , Director of MUY INTERESANTE.
Situation in Spain
The situation of the epidemic in Spain continues to be somewhat worrying, but there is good news. As Santiago Moreno, Head of the Infectious Diseases Service at the Ramón y Cajal Hospital, recalls, the number of people with HIV is between 140,000 and 170,000 : “The figure is high, but the important thing is that the number of new infections remains constant, between 3,000 and 4,000 people each year. “
Looking at the rest of European countries, the incidence figure stands at 80 cases per million, higher than that of neighboring countries . But what is most worrying is that there is still a significant percentage of non-diagnoses. According to data from 2016, 14% of people with HIV are still undiagnosed in Spain , although it is a figure that has decreased compared to previous years. The fact that we manage to reduce the number of undiagnosed, and not increase the number of new infected, is a good sign. It means that we are depleting the pool of HIV infection: they are not new infections, but new diagnoses.
Pharmaceutical companies is one more agent that has to contribute to infection control. In this sense, Marisa Álvarez, Medical Director of Gilead Spain: “Efforts must come from different agents, and the approach must be very comprehensive, from prevention and diagnosis to treatment. Once diagnosed, prompt treatment must be started: to be undetectable and not transmit the infection ”.
Prevention measures
When it comes to AIDS prevention, the first thing we need to make sure of is to prevent people from contracting the virus. In this sense, Santiago Moreno was clear about the route to follow: “We have to resort to measures that have been shown to be effective. These are PreP (Pre Exposure Prophylaxis); and early diagnosis of patients ”.
For his part, Ramón Espacio, President of the State Coordinator for HIV and AIDS (CESIDA), focused on the young population . “Access to sexuality is very early and youth have very few sexual references.”
Following the same reflection, Miguel Ángel Rodríguez Head of the Pharmacy Section of the Ramón y Cajal Hospital, alluded to the modernization of the campaigns: “We focus on delivering messages on the radio and the press, but prevention should be launched on social networks , like Instagram; to things that young people use every day ”.
Why is early diagnosis so important?
The late diagnosis brings with it, mainly, two very negative consequences. As Santiago Moreno explains: “As there are no symptoms at first, as long as the infection is not diagnosed, it will progress, which obviously harms the patient’s health. On the other hand, there is a detriment to society; the person does not know that he has the virus, and transmits it ”.
Today we know that a person with HIV who has received treatment can reach a state where the virus is undetectable. This means that that person can no longer transmit it. This great news has a very powerful emotional impact, on which Ramón Espacio had an impact, from the patients’ point of view: “You are no longer a virus with legs.” This also helps to eliminate stigma.
The role of primary care
Mónica Morán Arribas, Head of the HIV Prevention Section of the General Directorate of Public Health of the Community of Madrid, wanted to highlight the role of primary care: “Primary care, where most people go at least once a day. year, it is a fundamental scenario to promote the diagnosis ”. For this reason, professionals need to be prepared: “Ensuring that health workers know how to deal with the sexual life history of patients can be a strategy to favor an immediate diagnosis,” he explains.
In this sense, Miguel Ángel Rodríguez emphasized the need that, when a person is diagnosed by primary care, then “they do not get lost along the way” until they reach the specialist, so that they can be treated as soon as possible.
From left to right: Miguel Ángel Rodríguez, Marisa Álvarez, Santiago Moreno, Ramón Espacio, Mónica Morán, Enrique Coperías and Santiago de Quiroga.
HIV treatment
Since it was demonstrated in 1996 that triple therapy could suppress the HIV viral load, the pharmaceutical sector, represented in the debate by Marisa Álvarez, Medical Director of Gilead Spain, has the ambition to obtain drugs that allow more and more effective treatments and with fewer side effects, something that is being achieved.
From the point of view of treatments, two key issues were brought to the table in the debate: on the one hand, the tolerability of drugs. Over the years, the industry has managed to minimize adverse effects of antiretroviral drugs, such as bone problems, or kidney infection. Now, the treatments are very safe and effective.
As Marisa recalls, the survival of people living with HIV increases; they are going to age and combine the treatment with other medications, so it is important that there is no confrontation between them: “If patients feel ‘sick’ from having to take a daily pill all their lives, we must try to offer them other alternatives. That is the future, we must adapt to what patients ask of us. “
Regarding active listening to the patient, Ramón Espacio showed that it should go beyond the context of the clinical trial: “We want a listening measure that can be applied to daily life and that is reliable to obtain quality of life data ”.
Another fundamental aspect to deal with from the point of view of treatments is adherence. Miguel Ángel Rodríguez regrets that there are still 48% of patients who do not have complete adherence, that is, who do not follow the treatment perfectly . The good news is that the treatments are so effective that 95% of patients are still under control.
Comorbidity, a challenge at the health level
Treatment has made patients live longer and with a better quality of life. But that happens because of aging, which increases the risk of comorbidities. It should not be forgotten that AIDS has become a chronic disease, which implies a premature aging of the immune system.
As revealed during the talk, people with HIV have a higher incidence of comorbidities (one or more disorders in addition to the primary disease or disorder) than the rest. More than 30% of the population living with HIV is over 50 years of age. It is necessary to look for different approaches so that the patient can live with these comorbidities and look for the safest possible drugs that allow them to identify and prevent them.
On the other hand, psychological well-being is also an aspect that must be taken into account when evaluating the status of HIV patients. Mónica Morán expressed the need to assess the quality of life, the social, emotional or psychological point of view of the patient : “At the biological level we have a lot of data, but socially there is work to do. Society has to understand that people with HIV do not they have to suffer stigma and associated illnesses such as depression or anxiety. “
Outlook for the future
In Spain, 86% of people with HIV are diagnosed; more than 90% of these receive treatment and, of these, 95% are undetectable. The diagnosis becomes, therefore, the first major objective.
By 2030, UNAIDS marks the challenge in 95/95/95 : 95% of people with diagnosed HIV; 95% of them, with treatment; and 95% of them, with undetectable viral load.
Speakers:
Mónica Morán , Head of the HIV Prevention Section of the General Directorate of Public Health of the Community of Madrid.
Santiago Moreno , Head of the Infectious Diseases Service of the Ramón y Cajal Hospital.
Ramón Espacio , President of the State Coordinator for HIV and AIDS (CESIDA).
Marisa Álvarez , Medical Director of Gilead Spain.
Miguel Ángel Rodríguez Head of the Pharmacy Section of the Ramón y Cajal Hospital.
