“Caves are pre-exposure prophylaxis”
Rafael Rubio García, from the Internal Medicine Service of the 12 de Octubre University Hospital.
More than 40 years ago they started to discover the first cases of AIDS, a disease that broke out in the world and whose prognosis was not good. Over the years it managed to transform from a fatal for chronic pathology, but there are still challenges to overcome. Actually, to achieve in the future eradication of HIV you have to bet on pre-exposure prophylaxis (Preparation). This was stated by Rafael Rubio García, from the Internal Medicine Service of the 12 de Octubre University Hospital, this Friday the XII Infectious Diseases Conference of the Spanish Society of Internal Medicine (SEMI).
“The first HIV patients had access to therapies of poor efficacy and toxicitywith a very high morbidity and a very poor prognosis,” Rubio explained. Specifically, survival was six months to one year. “It was an inexorable path to death. During the years 1994 and 1995, in our department we diagnosed 250 patients and had 200 deaths per year“, he added.
However, the investigation changed the course of the disease and antiretroviral treatments to mark “before and after”: “It is the most appropriate intervention in the history of HIV“, assured the professional. Thanks to them, the incidence of AIDS is decreasing and the survival rate of patients is improving.
“Antiretroviral treatments are the most appropriate intervention in the history of HIV”
In numbers, access to this type of treatment is 73 percent of all people with HIV (27.5 million people in the world). However deaths remain high: 680,000 people die of AIDS-related illnesses in 2020. Rubio is clear, prevention and new preparative therapies will be the key to ending the disease, and there is a “diverse portfolio of drugs under investigation” to expand these treatments.
“Antiviral treatment improves the immune system, reduces inflammation and co-morbidities, but the toxicity and safety of the different regimens must be evaluated and the treatment individualized,” he specified. In this sense, bictegravir and dolutegravir are recommended by the main TAR guidelines as first-line regimens.
Likewise, Rubio cited the treatment of pregnant women as another of the “paradigm facts” as it means reducing mother-to-child transmission and the impact of introducing antiretroviral treatments in southern African countries. In global form, it has gone from 93 million infections in 1997 to more than half in 2020.
Although HIV treatment has evolved over these more than four decades, there are still outstanding challenges. First, Rubio clarified this between 40 and 50 percent of patients do not know they are infected and come to the hospital late. In addition, professionals find problems in the convenience of treatments. Therefore, to prevent patients from abandoning therapy, many new drugs are single tablets.
In this sense, the lines of research are currently based on three lines: new drugs, new formulations long-acting and curative strategies. One of the interesting therapies, Rubio said, is a therapy that combines long-acting cabotegravir/rilpivirine (CAB/RPV AP), which is expected to be approved by the Department of Health before the end of the year. It is an injection every eight weeks with good results.
The future of HIV treatment is assured as more and more options are available. On the one hand, there are the new drugs that inhibit the entry of the virus, such as fostemsavir and ibalizumab; islatravir, which is a reverse transcriptase translocation inhibitor; and lencapavir, which is a capsid inhibitor. They are characterized by reaching an undetectable viral load in less than a year, and some can be administered subcutaneously, he concluded.
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