Undetectable equals untransmittable, the new reality of HIV – Wellbeing is life

Undetectable equals untransmittable, the new reality of HIV – Wellbeing is life
Undetectable equals untransmittable, the new reality of HIV – Wellbeing is life

Dr. Miguel de Górgolas and Dr. Alfonso CabelloBy Dr. Miguel de Górgolas, Associate Head of Internal Medicine and Head of the Infectious Diseases Unit at the Jiménez Díaz Foundation University Hospital (Madrid); and by Dr. Alfonso Cabello, Associate Head of the Internal Medicine Service and the Infectious Diseases Unit at the same hospital.

Posted on July 4, 2024

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. More than 3,000 new cases are diagnosed in Spain each year, and there are 39 million people infected worldwide.

It is a silent disease for a long time and most patients do not realise it when they become infected or, at most, have a cold that goes unnoticed. Many years can pass, even 7-10, without symptoms, until the defences are destroyed, the immune system weakens (this is what the virus causes); so that all the complications or diseases associated with HIV infection arise.

1996 marked a turning point in the treatment of this infection, and a therapeutic strategy was developed that controlled the infection. The mortality rate decreased significantly, although the antiretrovirals used at the time were extremely toxic and caused many problems.

However, since then, there has been a real scientific race, and in this last decade new drugs have been designed that have left these problems behind, highly effective therapies that are extraordinarily well tolerated by the vast majority of patients, making them much easier to take.

The infection cannot be cured, but the latest treatments have enabled these patients to remain in perfect health throughout their lives. In addition, the aim of current treatments is to ensure that the virus is undetectable, so that the viral load is minimal and these people do not transmit the infection, thus enabling the immune system to recover quickly and those affected by HIV to lead a normal life, with a life expectancy practically like the rest of society.

The importance of early diagnosis

It is a viral infection that is transmitted in three ways: sexually, through blood or derivatives (with accidental injections or punctures), and from mother to child. To diagnose it, it is necessary to be alert and have the ability to detect and screen.

Diagnostic methods are now widely used. Previously, they were only available in hospitals, but today there are rapid detection methods that can be bought in pharmacies, which are completely reliable and sensitive. The main indication is to start treatment as soon as possible, even on the day of diagnosis, because there is no point in letting the immune system deteriorate.

Treatment combinations and preventing comorbidities

Currently, combinations of treatments are used in a single pill, taken once a day, with very good tolerance and enormous efficacy. This allows the infection to be controlled and a life expectancy practically equal to that of the uninfected population.

In addition, treatments are now also available that are administered intramuscularly, with two injections every two months.

Among the comorbidities associated with HIV is the risk of developing tumors (lymphomas and other cancers) as well as cardiovascular diseases. This is due to a persistent inflammatory state that does not subside with antiretroviral treatment. Specifically, it is estimated that the incidence of cardiovascular disease in patients with HIV is approximately double that of the general population; and to prevent them, cardiovascular risk factors must be controlled as much as possible.

Despite all the progress made in this pathology, the rejection and social stigma behind this disease is very high, and this has repercussions at a social, family and relationship level that in many cases affects the mental health of people living with HIV. Therefore, it is essential to put an end to misinformation and stigma and show that life goes on thanks to both scientific and sociocultural advances.


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