December 1st is World Aids Day. Since the first cases of HIV were announced over 35 years ago, 78 million people around the world have contracted it and 35 million have died from related illnesses. However, during this time it has passed from being fatal to chronic, thanks to new innovations and medical advances which have also improved the lives and health of patients with other illnesses.
The aim of the United Nations is to put an end to the Aids epidemic as a threat to public health by 2030. To do that, the number of new infections needs to be drastically reduced and the trajectory of the epidemic has to be changed.
The UN considers that putting an end to the Aids epidemic would produce advances in the whole spectrum of civil, cultural, economic, political, social, sexual and reproductive rights.
Defending the rights of all people, including children, women, adolescents, men who have sex with men, drug users, male and female sex workers and their clients, transgender people and migrants is fundamental, says the UN, in order to guarantee access to the services which save lives. In addition, investing in science, innovation and strategic information will help to achieve these ambitious objectives.
Advances so far
Dr Roger Paredes is the Scientific Director of the 'Lucha contra el Sida' Foundation. In his opinion, the greatest advances during these years have been in three main areas: research, treatment and prevention. In the first of these, it involved identifying and preventing the infection at the same time as providing those infected with better treatment.
"The challenge for the future will be to eliminate the infection in patients," he says. These treatments and advances have enabled the infection to be classified as chronic. "Most are combinations within one pill now, and clinical tests are being carried out with the aim of reducing treatment to once a month or even once every three months," he explains.
With regard to prevention, the advances have to do with prophylaxis. "The objective is to ensure that everybody infected is treated. As well as improving their health, it would mean the virus was not transmitted," says Dr Paredes.
A future cure?
However, the greatest challenge is still finding a cure. "Plenty of research is being done, but we need to know more about the illness, the reservoirs (places in which the virus 'hides') and stimulate the immune system so it is able to destroy the illness, as is now being done in some types of cancer," he says.
The results of the research into the fight against Aids is not limited to this illness, as it also enables advances with regard to other conditions.
"We have never learned so much or advanced so far as we have with Aids. It is the infectious illness in which we have progressed most, and it is extraordinarily complex. However, there is still a long way to go," says Dr Paredes.
This expert explains that a great deal more knowledge has been gained about other illnesses, such as Hepatitis C. In this field, they have learned a lot more about the reservoirs. "When we know how to identify the reservoirs, see how they work and tackle them, we will be closer to a cure for the illness," he says.
Also, although cancer is a very different illness, they do share some aspects. For that reason scientists are also trying to make progress on involving patients' immune systems.
Access to drugs
The UN says that of the approximately two million people worldwide with HIV in 2014, nearly half lived in eastern and southern Africa. Around 22 million people who live with HIV do not have access to antiretroviral therapy. Among children, access is terribly low, with a coverage which ranges from 54 per cent in Latin America to 15 per cent in the Middle East and North Africa.
Roger Paredes recognises that this is, precisely, another challenge which has to be overcome: for medication and all its benefits to be available in developing countries. "Some pharmaceutical companies have taken very important decisions. ViiV decided to make its most important drug cheap, or cheaper than the rest at least, and that has meant that patients with resistent virus (more than ten million altogether) can be given these drugs," he says.
Another major objective is for everybody who is infected to be aware that they are carriers of the virus. Although there have been advances in encouraging people to be tested, half of those who live with HIV are not aware of it, according to the UN, which stresses that late diagnosis of an HIV infection is the biggest barrier to its treatment.
In Spain, these tests are free of charge at any health centre. There are even rapid tests available from chemists, so people can find out if they have HIV. "I would advise everybody to have a routine check, especially those who are most exposed. The best thing is not to be infected, but if you are, then the next best thing is to be treated as quickly as possible and not to transmit the illness," insists Dr Paredes.
Unlike bacterial illnesses which are attacked with antibiotics, doctors can use vaccines to try to prevent those produced by a virus.
Would it be dreaming to suppose that there could be one against this illness?
Roger Paredes explains that there are two types of vaccine: those which prevent infection and those which are therapeutic.
The former would be very difficult to achieve in the case of Aids, he says, "because we don't know the response which can occur when the HIV enters the body". The complexity in this case is that there are many types of HIV.
"It's a bit like all the different types of flu in the world. It's hard enough for the scientific community to come up with a flu vaccine every year, and for Aids it would be an even greater challenge," he says.
"It is very important that there is a vaccine of this type, but it is a huge challenge and won't happen in the near future. With regard to therapeutic vaccines, these are used as immunotherapies, 'showing' the virus to infected people so that their immune system detects and destroys it. That is more feasible, and is one of the strategies being researched".