Dr. Bonaventura Clotet (Barcelona, 1953) has dedicated his life to fighting HIV, a pathogen that today has disappeared from the headlines of the media but that only three decades ago segated the lives of millions of people around the world.
From Irsicaixa, a non -profit private research institute sponsored by the Generalitat de Catalunya and the La Caixa Foundation, directs a multidisciplinary team dedicated to the study of the immune system as a weapon to combat infectious diseases. This is the first part of an interview with Clotet, who tells us about infectious diseases, if we are winning the battle against AIDS and how they will affect research cuts in the United States to this global crusade.
In 1995, the date of the creation of Irsicaixa, AIDS ended the lives of 5,857 people in Spain. In 2021, that figure had dropped to 306. Are we definitely winning the battle against HIV?
It depends on how you look. A lot has been made in HIV control. For example, the life expectancy of people who begin a treatment early is today as that of an uninfected person.
Not only that, in Sub -Saharan Africa, the region with the highest incidence of HIV in the world, studies with intramuscular injections treatments have been recently carried out, which applied even only once a year, can also prevent infections.
The long -term objective is to find an effective preventive vaccine. Until this is possible, the potential of therapeutic vaccines are being demonstrated, such as the one developed in Irsicaixa by Cristian Brander, the first that, combined with other treatments, has proven to be fully effective
The current problem is that the reduction of aid for research against AIDS – and other scientific investigations – carried out by the United States Government ends up harming nations where there is a high prevalence of this disease, such as South Africa or Lesoto, some countries that are also victims of the new tariff policy imposed by the United States.
And that can make treatments and preventive therapies very difficult, very effective tools that have a cost but to be effective they should be distributed free of charge.
To the ancient antiretroviral treatments today the so -called therapeutic vaccines and preventive treatments are added, what exactly are they?
Pre -exposition therapies (PREP) work very well. It simply consists of taking a tablet per day. They have, of course, limits, because it only provides HIV infection. They do not act against other sexually transmitted diseases.
In addition, there is another treatment called post-exposition (PEP) for those emergency cases. For example, health personnel who have infected or people who have had risk relationships. The problem is that these drugs should be administered for free to be effective, especially in developing countries.
In Europe, where there is a lower incidence, we should use these methods to get cities free of AIDS. In Barcelona there are about 200 new cases every year, something that would be avoided generalizing pre -exposition therapy. The objective is that the important cities of the world encourage the use of this type of treatments to achieve 0 infections.
How exactly does it work? Is it 100% effective?
That’s how it is. For those who have risk sexual relations it is recommended to take the pill regularly. Otherwise, it is advisable to do so when this situation can occur. This therapy is called pre -exposition on demand. The problem arises when you have an occasional risk relationship, but if you anticipate that at some point this risk situation can occur, it is best to take these pills as a preventive method.
I know one thing is to say it and another to do it. But sometimes we forget that with a single risk relationship you can already infect, even if it is occasional. I am aware that the population cannot be asked to always take a medication in case. In addition, it is not always available in all public spaces, although in some large cities, such as Barcelona, it can be found in some special centers, such as Checkpoint, in Barcelona.
Another effective measure is the therapeutic vaccine, applied to infected people. It is an injection that, administered from time to time, could control the virus. It is currently in the phase of clinical trials, although it has shown that it can activate the immune system to act against HIV, it must be combined with the administration of neutralizing antibodies that block the virus and other strategies aimed at destroying viral reservoirs that have the pathogen in the latent phase.
“Sometimes we forget that with just a risk relationship you can get infected with HIV.
The first therapeutic vaccine that demonstrated efficacy was developed in Irsicaixa, and gave rise to a spin off which was later acquired by the international multinational Gillead, who hopes that he can develop it in combination with other strategies, such as neutralizing antibodies.
The most relevant thing about AIDS research is that in all these decades we have not only learned to fight HIV, but also to know well the functioning of the immune system and the control of infections.
All centers that began investigating AIDS between 30 and 35 years focus today on studies on infections and immunity, from new cancer therapies to multirresistant bacteria, as well as methods to combat possible pandemics caused by viruses that can mutate.
In addition to the therapeutic vaccine, your equipment works in a preventive vaccine. Why is it so difficult to get a vaccine that finally ends with HIV?
The preventive vaccine is extremely complicated to achieve, because the virus mutates very easily, which is difficult to cover all variants. Until now a humoral response was pursued, that is, based on antibodies. Now we work in a vaccine that incorporates a cellular response, which gives a better prevention perspective.
The ultimate goal is not only to keep the virus under control, but completely eradicate it, as it has been achieved in that thirty people who have managed to overcome the disease after having undergone a marrow transplant.
Indeed, stem cell transplant has become an important weapon, not only to control, but to cure HIV. There are several cases of patients – as the so -called Berlin, New York, Geneva – who have been completely cured with this method. Is this the method to follow?
These patients underwent a bone marrow transplant because they had another hematological disease that required this intervention. Some of them left the treatment, but not everyone did.
The problem is that the transplant has a mortality risk of 20%, a threshold that should not be assumed in infected people who can live without resorting to this procedure. At present, antiretroviral treatment is highly effective and allows people to live with a normal life expectancy, without exposing themselves to the dangers associated with stem cell transplant. This strategy, therefore, is not applicable in a generalized way. Although antiretroviral treatment does not cure the disease, it does allow you to continue living normally.
“In Barcelona, about 200 new HIV infections are counted every year.”
On the other hand, of the various dozens of people who have undergone the transplant, only 7 have been able to say that they have stopped the medication and it has been possible to demonstrate that the virus does not appear in the absence of treatment. When they make you a transplant you cannot stop the medication at once, it is necessary to make sure that you have no residue with the virus.
Even so, the fact of having cured of the disease does not mean that you cannot infect yourself again, with what it should follow, if it is exposed to risk, a preventive treatment.
And it would not be better to use a condom? Have we lost the fear of infection?
The use of condom is complex. A lot of sex education should be done in schools. The reality is that many people have lost their fear of sexually transmitted infections (STIs), and classic prevention methods, such as the use of condoms, tend to be used less frequently. PREP is a very effective tool to prevent HIV transmission, but does not protect against other STIs, such as HPV, herpes, syphilis … You have to do an important job since adolescence, explaining well how to have healthy, respectful and safe sex. In other words, you have to talk about sex without capujos, especially among teenagers.
