Three most encouraging developments in the fight against HIV/AIDS

August 16, 2023

Originally posted by BBC Mundo on December 1, 2022

It’s not necessarily a death sentence anymore.

This is the most encouraging message from those working in the fight against the human immunodeficiency virus (HIV).

Since the first cases were reported in the 1980s, more than 40 million people have died from causes related to HIV and the most advanced phase of the infection it causes, acquired immunodeficiency syndrome (AIDS).

The World Health Organization (WHO) estimates that last year alone it claimed 450,000 lives and 1.5 million contracted the virus. The agency estimates that 38.4 million people are living with HIV, of which more than two-thirds are in Africa.

Although thanks to early diagnosis and increasing access to medicines, it has become a treatable chronic health problem in many parts of the world. There are even countries that are close to eliminating it.

“We have been doing research for 40 years, and although we do not have a vaccine, important developments have been made to combat it, treat it and improve the lives of those who have it,” David Goodman-Meza, a professor at David University. Goodman School of Medicine, told BBC Mundo, Geffen of the University of California, Los Angeles (UCLA), specializing in research on the subject.

On December 1st, World AIDS Day, we bring you three of the most promising achievements.

1. More effective (and convenient) antiretrovirals

HIV attacks the immune system and weakens the defense against many infections and certain types of cancer that people with stronger immune systems can deal with more easily.

This can be addressed with antiretroviral therapy or ART.

In fact, since 2016 WHO has recommended lifelong ART for all HIV-infected people, including children, adolescents and pregnant women, regardless of their clinical status.

As a result, 28.7 million HIV-infected people worldwide were receiving antiretroviral treatment last year.

This drug combination does not cure the infection, but it does suppress the replication of the virus in the body and allow the immune system to regenerate.

“In addition, over the past years we have learned that effective treatment reduces the risk of transmission by 100%,” Ayako Miyashita of the California HIV/AIDS Policy Research Center (CHPRC) told BBC Mundo. English).

“When a person has an undetectable viral load, they cannot pass HIV on to anyone,” he continues. “And it’s a vital element not only in fighting the disease, but also in fighting the stigma associated with it.”

In addition, there have been “revolutionary” advances in these treatments in recent years, he notes.

“The situation has changed a lot since the 1990s or early 2000s, when patients had to take several pills a day, which led to many side effects,” explains Professor Goodman-Meza.

Today, the treatment consists of one tablet per day and does not cause serious complications. Although innovation in this area continues, researching long-term treatments.

Last year, the US Food and Drug Administration (FDA) approved the first long-acting treatment, a two-drug injection every two months.

“Imagine what this means for those who have been addicted to daily pills for decades,” Miyashita emphasizes.

For Susie Steward, 62, who has been living with HIV since 2006, it was the best thing that has happened to her in 15 years. He participated in clinical trials, and when they were approved, he says he cried with excitement. “I was really fed up with the pills that reminded me of my diagnosis every day,” she told Healthline.

In addition, studies are under way on alternative treatments for patients with antiretroviral drug resistance.

“There have been great advances in treatment, but the real revolution has been in prevention,” says Miyashita, co-director of the CHPRC Center in Southern California.

This refers to pre-exposure prophylaxis, better known as PrEP.

If PrEP is taken daily, it can reduce the chance of contracting the virus that causes AIDS through sex by more than 90%, or by 70% when using unsterilized needles or when used by multiple people, according to the US Centers for Diseases. Control and Prevention (CDC).

The American pharmaceutical company Gilead Sciences began marketing it in 2012 under the Truvada brand.

And three years later, the World Health Organization (WHO) began recommending its use for HIV prevention among groups at high risk of infection, such as gay men, bisexual men and their partners, sex workers or women. with this virus.

But although its results are already visible in developed countries, the high cost of this treatment keeps it away from the most vulnerable areas.

“Recently, long-acting injectable PrEP has also been approved,” says Goodman-Meza.

He cites, for example, clinical trials of sustained-release injections conducted in South Africa, which proved to be very successful: they almost completely eliminated the risk of acquiring HIV to participants and were 88% more effective than pills they took every day.

This issue was raised at the International AIDS Conference, an annual gathering of researchers, policy makers and activists, held in Montreal, Canada, in late July and early August.

In recent years, the rate of HIV infection has leveled off, and injectable PrEP has become the first of a new technology that has long bode well for HIV prevention.

3. Vaccine research

Despite four decades of research, there is still no vaccine for HIV.

The most recent development efforts include clinical trials of three experimental vaccines based on synthetic messenger RNA (mRNA) technology already used in some COVID-19 vaccines.

Conducted by the National Institute of Allergy and Infectious Diseases (NIAID), it is still in its first phase.

“Finding an HIV vaccine has proven to be a scientific challenge,” then-NIAID director Anthony S. Fauci, now chief medical adviser to the President of the United States, said when trials began in March.

“With the success in developing safe and effective vaccines against covid-19, we have a great opportunity today to see if we can achieve similar results against HIV infection.”

“At the moment, there is no effective vaccine and no cure,” says Miyashita.

Cases are known where patients are believed to have been cured or have been free of the virus for at least several months.

But these cases are the result of new and experimental treatments that are not easy to apply to all victims.

“One of the things that we cannot forget is that there are people living with HIV now, and until we achieve this, not only vaccines, but also drugs, we still have a lot of work ahead of us,” the expert emphasized.

Also remember that not all countries benefit from scientific advances in this area.

“Equality in access to health and safe treatment is not something that has been achieved globally. So it doesn’t matter how much progress has been made in biomedical interventions. If we don’t achieve equality of access, we won’t see the end.” HIV.”

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