The irruption of COVID has meant an almost total monopolization at the media level of information and conversation about health. However, other epidemics continue to affect millions of people on a daily basis and it is essential not to lose sight of the importance of continuing to invest resources in their prevention, treatment and eradication. In this context, one of the main challenges is represented by the HIV/AIDS epidemic. According to UNAIDS figures in 2021 38.4 million [33,9 millones–43,8 millones] people were living with HIV worldwide in and that same year 1.5 million [1,1 millones–2,0 millones] of people became infected with HIV. Deaths from AIDS-related diseases in 2021 amounted to 650,000 [510.000–860.000]rising to 40.1 million [33,6 millones–48,6 millones] people who have died since the beginning of the epidemic.
Although currently, thanks to progress in the field of retroviral therapy, it allows people infected with HIV to live a full and normal life (mostly with viral suppression), there are still many challenges to be able to consider eradicating this epidemic. Especially vulnerable are developing countries and people belonging to groups at risk of exclusion and vulnerable.
To hear from an expert the current reality of the HIV/AIDS epidemic, to shed light on myths and prejudices around the subject, and to find out what challenges people with HIV and health systems face, we contacted the Dra. Leda Pedelini GassmannPhD in Biological Sciences and director of the Official Master’s Degree in Epidemiology and Public Health at VIU.
Although there is ample information available on the subject, there is still some confusion about some basic terms. Can you explain to us what HIV, Seropositive and AIDS mean?
He HIV (human immunodeficiency virus) It is a virus that attacks the immune system, hence the name. Like SARS-CoV-2 and so many other viruses, HIV infection in humans came from an animal. In this case, the jump to the human species occurred from a Central African chimpanzee. It was probably from hunting these chimpanzees for their meat and coming into contact with infected blood.
HIV infects a type of immune system cells called helper T lymphocytes or CD4 cells. As the virus replicates, it destroys the infected cell and produces more virus that infects more CD4 cells. Without treatment, this cycle can continue until the immune system is severely compromised. He acquired immunodeficiency syndrome (AIDS) It is the most advanced stage of HIV infection. At this stage, the immune system is severely weakened and the risk of contracting opportunistic infections is much higher.
When the analysis of a person’s serum shows the existence of specific antibodies against HIV, that person is said to be seropositive. Therefore, when one wants to know whether or not someone is infected with HIV, this type of analysis is used to look for specific antibodies against the virus.
UNAIDS has set itself the goal of ending AIDS by 2030. At what point are we in this regard? Do you think it is feasible to achieve it?
The incidence of HIV continues to rise, especially in some African countries. Although the number of deaths caused by HIV has decreased, there is an increase in morbidity and mortality associated with co-infections, such as tuberculosis and viral hepatitis. Furthermore, stigma and discrimination continue to hinder access to health services, particularly for children, adolescents, young women, and key populations such as sex workers.
Among the objectives of UNAIDS for 2030, is the absence of discrimination, that 95% of people living with HIV are aware of their serological status, that 95% of seropositive people receive treatment and that 95% of people on treatment have a suppressed viral load. We still have challenges to overcome, but we are on the right track. In 2021, of all people living with HIV, 85% knew their status, 75% had access to treatment, and 68% were virally suppressed. To end the AIDS epidemic, we must prioritize HIV prevention to reduce the number of new infections, expand access to testing to detect new cases, and expand antiretroviral therapy services.
“With the right treatment, you can have an undetectable viral load”
What are the main problems facing people with HIV today? How do socioeconomic conditions influence the quality and life expectancy of people with HIV?
As long as they are on treatment, most people with HIV can enjoy full social and professional lives. The problem is that not all people have access to treatment. Unfortunately, the presence of HIV infection in adults, in unfavorable socioeconomic conditions, is linked to poorer health, stigma and poverty.
People in developing countries are considered to be at higher risk of developing AIDS because of their lack of access to health care services and information about AIDS. In turn, misinformation leads to stigma and discrimination. Finally, AIDS affects the development prospects of these countries. In the most deeply affected countries in Africa, one in five adults of working age has HIV. The people affected are the drivers of the economy. Without them, countries will remain trapped in poverty.
How has COVID affected the global fight to prevent the spread of HIV?
The COVID-19 pandemic has had negative repercussions in the fight against HIV, but it has also led to the deployment of strategies that benefit it.
On the one hand, part of the funds dedicated to HIV prevention, diagnosis and treatment programs were redirected to COVID-19, so that less was invested than in previous years.
Nearly 38 million people are living with HIV worldwide, the majority in low- and middle-income countries. These people are at higher risk of developing clinical complications and requiring hospitalization when infected with SARS-CoV-2, and have suffered notable interruptions in the services that care for them.
The other side of the coin, however, is that, to deal with the COVID-19 pandemic, strategies that benefit the fight against HIV were implemented. For example, the success of the RNA technology used in vaccines against SARS-CoV-2 has opened the door to the development of a potential effective vaccine against HIV.
3D medical model of the Human Immunodeficiency Virus
Is there still a lot of ignorance about the reality that people with HIV live?
I think so. Despite increased awareness about HIV and advances in treatment, many people living with the virus still face stigma and discrimination. Prejudice stems from myths, fears and a lack of education about HIV. In addition to violating the fundamental rights of these people, this represents a barrier to progress towards the elimination of HIV. The stigma makes it difficult for risk groups to access education, tests, but also treatment and adherence.
Can you point us to some of the main myths that exist around HIV and AIDS?
We must banish ideas such as that people with HIV cannot enjoy a full sexual life, that a couple with HIV cannot have children or that a woman with HIV who has had a baby cannot enjoy breastfeeding. With proper treatment, you can have an undetectable viral load and this viral suppression can be maintained over time. This, along with other protective measures, prevents the transmission of the virus to other people.
The form of transmission must also be demystified. We are not going to get HIV from a mosquito or tick bite, or by contact with the saliva, tears or sweat of an infected person or by hugging them, using the same toilet or sharing a glass.
What measures are fundamental when it comes to preventing HIV infection? What therapeutic options are available to people infected with HIV, and how does the prognosis of someone infected today differ from that of someone infected in the 1980s?
To prevent contagion, it is important to be informed to avoid risk behaviors. HIV is mainly spread by having sex or sharing needles with someone who is infected. Substance use may indirectly contribute to increased risk of infection because alcohol and other drugs cause disinhibition and may make one less likely to use protective measures.
Throughout its 40-year history, great strides have been made in the field of antiretroviral drugs. The first generation of drugs at the end of the 80s, such as AZT or retrovir, had great toxicity and forced patients to take them at very strict times, many times a day and with very rigid guidelines regarding meals. It was not uncommon that, with the appearance of the first toxic effects, the patient decided to abandon the medication.
However, currently, there is a whole arsenal of drugs to combat the virus. Although none of them, alone or in combination, is capable of destroying the virus, they manage to stop its multiplication and, therefore, its ability to harm us. This control over the possibilities of multiplication of HIV within the body ensures that the infected person does not develop the infections that previously led to death and that they can live a long and healthy life.