Fortunately, people who are detected HIV Today they will live a completely different experience than those who were diagnosed three or four decades ago thanks to the medical improvements produced during this time and, fundamentally, the introduction of antiretroviral therapy (ART). However, we must avoid false belief that HIV does not require social and health intervention. Although a large part of society mistakenly thinks that it is part of the past, the reality is that it continues to pose challenges at the comprehensive health, economic and social levels. These are new times, with new challenges that must be responded to.
To talk about all this, the round table «Current challenges for the management of HIV»organized with the collaboration of Gilead, in which the Dr. Maria Velascospecialist in Infectious Diseases and Tropical Medicine at the Alcorcón Foundation Hospital; Reyes Velayospresident of Cesida, (State HIV and AIDS Coordinator); Elena Tortajada, pharmacist at the Hospital Pharmacy Service of the Jiménez Díaz Foundation, Madrid; and Pau Arbosdirector of the HIV Unit of Gilead Spain and Portugal.
One thing everyone agreed on was that there is still stigma surrounding HIV. «More than 40 years later, the stigma is not as it was at the beginning, but it is very relevant, and it is what worries us the most. If we do not end the stigma, we will not be able to do so with the virus,” said Velayos. Because, he continued, the stigma is in the daily lives of people with HIV: “They encounter it in the work or healthcare environment many times as soon as they leave the infectious units. But also in the rest of society and in the media. At Cesida, we continue working to end this stigma with projects such as ‘Positive Pride’which for the third year will hold a march on October 19 for the rights of people with HIV.” Faced with this reality, the participants insisted that Living with HIV today is the same as living with any other infection and you can have a completely normal life.
In most cases, stigma stems from misinformation: «One of the great advances is the I=I concept. That is, undetectable is equal to untransmittable.. Many people still do not know that a person with HIV in whom the virus is not detectable in a blood test cannot transmit it. We must insist on this message and continue to educate and inform the population,” said Arbós. That is why “At Gilead we work to find a way for the information to reach the person who needs it.. This requires being innovative and being present where the groups to raise awareness are, for example by reaching them through the digital environment, from where we offer rigorous information through our websiteEresvihda.es.
Hospital pharmacies are also taking an active role in finding solutions to the stigma of HIV, with initiatives such as reducing visits to the center by expanding the dispensing of medication or sending it directly to the person’s home, as Tortajada pointed out: “Today Nowadays you can perfectly make a Non-face-to-face pharmaceutical care with adequate follow-up to the patient”.
Late diagnosis
Currently, half of HIV diagnoses in Spain are made late, and there are also around 10,000 people with hidden infection who do not know it. This has implications for the health of the person with HIV, public health and the health system. As Dr. Velasco explained, “late detection means that the person will have a greater amount of virus and it has done its job destroying their defenses, therefore, they will have a much worse immunological situation. The patient will be much more likely to have serious infectious complications or other HIV-associated diseases, such as tumors.. It also has a social dimension: a person diagnosed late could have transmitted it to others if they have not taken precautions. “This is a challenge because there are some populations that are especially disadvantaged in late diagnosis, such as older people and migrants.”
To reach this population, NGOs play a fundamental role, but initiatives such as “Deja Tu Huella”, by the Spanish Society of Emergency Medicine in collaboration with Gilead, are also decisive, which helps diagnose HIV from the Emergency Department. the hospitals.
“Thanks to her, 1,600 people have been diagnosed in these services in three years,” said Arbós. Late diagnosis also entails an economic cost.: «The results of a study published in 2022 in which I collaborated show that simply delaying treatment from five to 35 days entails an estimated cost of 1.5 million euros. In addition, if we delay diagnosis, we cannot do so when treating as well,» lamented Tortajada.
Treatment resistance
The generation of mutations of the virus that make it resistant to antiretroviral treatment This is, without a doubt, one of the great challenges posed by HIV. We must value and take care of the low level of resistance that has currently been achieved. Resistance to treatments compromises the health of the patient, in whom not only the drug to which the virus has become resistant does not work, but also all those belonging to the same therapeutic family, reducing the effective pharmacological options.
In addition, they also constitute a public health problem: Failure to achieve virological suppression with a treatment means that the virus is detectable and, therefore, transmissible to others with the aggravating factor that the mutated and treatment-resistant strain could be transmitted, complicating the prognosis of the infected person. «In Spain it is estimated that there are about 500 multiresistant people, that is, with resistance to at least two therapeutic families.. They are a very small group but the most affected by HIV. They are at constant risk of suffering opportunistic infections and could progress to AIDS and even die in the most extreme cases,” explained Arbós. “When they appear, what we can do is give ART for resistance, but they do not have the same level of success, they produce more interactions and make it difficult to manage the infection,” added Velasco.
Fragile patient
Advances in HIV treatment have led to survivors over 50 years of age. What’s more, it is estimated that today one in two people with the virus is older than this age and that they need a different approach than that of young adults. This implies certain unknowns in the management of this patient profile, with which there is no previous experience. «We lack information about how HIV infection fits into other diseases or comorbidities that appear when aging, such as hypertension, diabetes or chronic lung diseases., and we have the challenge of finding out how it impacts the evolution of these pathologies,” explained Velasco. And not only, then, as the most pressing challenges posed by the virus have been resolved, other issues such as anxiety, depression or insomnia are being looked at. “Between 10-50% of people with HIV may have neuropsychiatric problems,” he noted.
A final challenge, despite the literature that already exists, is the risky practices such as chemsexa type of sexualized drug use that, when problematic, in addition to posing a risk to the mental health of those affected, also impacts public health, which is why Velayos points out the “Need for collaboration between all entities involved: Administration, Health, NGOs, etc., and work together.”