Recommendations in the global fight against HIV

The HIV continues to be one of the biggest problems for public health globally, despite there seems to be a growing social perception that this is a solved problem It does not constitute a health emergency. In the most developed countries, prevention and information actions, early diagnosis and access to treatment have made HIV a chronic disease. However, in the poorest countries where HIV continues to cause thousands of infections, the picture we see is very different.

Since the first cases were diagnosed in the early 1980s, it is believed that more than 78 million people have been infected by the human immunodeficiency virus (HIV) and more than 39 million people died Due to As or related diseases. According to 2020 data published by UNAIDS, 37.7 million people are living with HIV, of which 1.7 million are children under the age of 14. 53% of all people living with HIV are women and girls.

Since the peak reached in 1997, new HIV infections were reduced by 52%. In 2020, there were 1.5 million new infections, compared to three million reported in 1997. Since 2010, new HIV infections have declined by approximately 31%, from 2.1 million to 1.5 million in 2020.

In June 2021, 28.2 million people had access to antiretroviral therapycompared to 7.8 million in 2010. UNAIDS reports that since the peak in 2004, AIDS-related deaths have fallen by more than 47%, but in 2020 approximately 680,000 people around the world have died from AIDS or related diseases, compared to 1.9 million deaths in 2004 and 1.3 million in 2010.

Since 2010, mortality due to AIDS has decreased by 53% among women and girls and by 41% among men and boys.

“It is feared that there will come a time when developed countries will not be able to afford the cost of antiretroviral drugs, given the survival of patients on treatment, the increase in the number of annual cases, the high drug costs and the need for lifelong treatment.

Although the data show positive trends in the fight against HIV, pandemic caused by the SARS-CoV-2 it has hit prevention programs, access to treatment and diagnosis hard.

The Global Fund to Fight AIDS, Tuberculosis and Malaria reported that, based on data collected from 502 health facilities in 32 African and Asian countries, HIV testing decreased by 41% and referrals for diagnosis and treatment decreased by 37% in the first Covid-19 Lockdowns 2020compared to the same period in 2019. It should be noted that the Sub-Saharan Africa it is home to 67% of all people living with HIV in the world.

The Economic load that is associated with the disease is very high and will continue to increase in the years to come, with an overall budget to tackle this problem by 2021 of 397 to 727 billion dollars. “It is feared that there will come a time when the developed countries do not have the ability to afford the cost of antiretroviral drugsgiven the survival of patients on treatment, the increase in annual cases, the high cost of drugs and the need to administer the treatment for life”, they specify. Jose Alcami Pertejo (Carlos III Health Institute) and Santiago Moreno Guillen (Ramon y Cajal University Hospital), in the book “Infectious diseases in 2050”prepared by the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc).

“With good resource planning, aggressive intervention with effective public health measures and expected scientific advances – development of a effective preventive vaccine– HIV should be on the way to eradication as an infection within the next 30 years,” the experts stress.

“Unfortunately, the lack of a comprehensive approach to the pandemicthe lack of investment in research aimed at a cure and in the development of vaccines and the inadequacy of preventive measures are pushing away this optimistic view,” they predict.

Reasons why in the current context “the most probable scenario is that of a long-term endemicity which will last for decades to come, if there is no intervention at the global level, both in industrialized countries and in countries with fewer resources”.

In the current context, “the most probable scenario is that of a situation of long-lasting endemicity which will last for decades if there is no global intervention, both in industrialized countries and in countries with fewer resources”

“We are faced with a radical dilemma: eradicate HIV infection in a generation or maintaining the current situation of a chronic infection with a slow but gradual increase in the number of patients and a significant health cost both for the patients and for the health system as a whole”, they warn, stressing that improving the situation of HIV requires interventions aimed at minimize new infections, thus improving the situation of people living with HIV (PLHIV). On this basis, they propose:

Medical for reduce new HIV infections:

  • active policy for diagnosis and treatment of people infected with HIV unaware of their infection (hidden fraction). Currently, it is estimated at 14% of all infections, but they are responsible for the vast majority of new infections. With the treatment of infected people, the chain of transmission is stopped and it has been estimated that if all people infected with HIV were identified and treated, there would be no new infections in a few years. Measures are proposed for this purpose. This is the priority measure because of its impact and ease of implementation.
  • development of pre-exposure prophylaxis (PrEP) programsin addition to the previous one, so that they affect all groups with risky practices.
  • insist on the educate young people on transmission prevention measuresincluding the two mentioned measures and physical protective barriers.
  • Promote and support research into biomedical interventions (HIV vaccines and cures).

Medical for improve the situation of people living with HIV:

  • Active policy of diagnosis and treatment of people infected with HIV who unaware of their infection (hidden fraction). Early diagnosis and treatment are associated with increased survival and less consumption of health care resources.
  • Guarantee access to health care for all PLHIV, including people from other countries, even in an irregular situation. As this is a disease whose transmission is prevented by treatment, it should be avoided that those diagnosed do not receive treatment and may continue to be transmitters among their contacts.
  • Create devices that make it possible to address the comprehensive management of HIV infection as a chronic diseasewith adequate communication between the different levels of health (primary care and hospital care) and the different professionals (doctors, pharmacists, nurses, prevention specialists, social workers, etc.).
  • promote the fight against stigma and discrimination PLHIV because of their disease.
  • Support research for improved models of care and the solution to the most important diagnostic, therapeutic and preventive problems of our environment.

Because we all need health…

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