New focus on disease risk

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new focus on disease risk

There is no cure but there is treatment, which is more effective and comfortable so as not to lose compliance with it. AIDS, for many years, is a chronic disease that people live with throughout their lives and “its survival curve is very similar to that of any other person. Other comorbidities, they require additional treatment. -care for age but it has nothing to do with the origin of the epidemic, it is already under control. Of course, they age earlier, in the sense that diseases that are common at 70, they already suffer at 60,” explained Dr Carlos Dueñas, head of Infectious Diseases at the Valladolid Clinic.

However, without the large numbers at the end of the 20th century, the reduction of infections was still a pending issue and for about ten years the numbers remained stable, frozen, without’ y desired reduction. There is more information, it is better known, there are ways for early detection but there is a way to go, even with the optimism of a promising future. The goal of the World Health Organization – which commemorates World AIDS Day today – is that, by 2025, 95% of people with HIV should have a diagnosis, 95% of them in treatment. antiretroviral drugs (ART) that save lives, and 95% of infected patients should be able to suppress the viral load, for the benefit of their health and to reduce HIV transmission. Spain stands at 96%, 95% and 92%, respectively. “We are very well,” thanked Dr. Dueñas.

There are two main developments that promise to reduce transmission and improve early detection. This is how the head of the Internal Medicine Service of the Clinic describes that, more than a year ago, the hospitals of Castilla y León launched AIDS prevention therapies for cases of risk behavior due to ‘chemsex’ parties. of drugs and rotating sex where partners often change and transmission is easier. «In the past, these sex parties were focused on Madrid and big cities; but the practice has reached Valladolid and other points or they will travel to Madrid to participate in it. The truth is that they are dangerous behaviors that require monitoring and prophylaxis,” he stressed. In November 2019, the Ministry of Health approved HIV Pre-exposure Prophylaxis (SIPrEP) programs; but the pandemic delayed its effective launch, which took place at the end of 2021. The Valladolid Clinic provides a weekly consultation for these people and, in the last long year, it has already added a hundred people to program. The majority comes from ‘chemsex’ but it can also happen due to other risky behaviors, in couples where one is infected for example,” he added. The Hortega River added another fifty.

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«In these parties, the consumption of stimulants and drugs is common, associated with the practice of sex between men and men, transsexuals are also common … it is collective sex, always changing -other partners. And not always having condoms or using them well. Therefore, to prevent the spread of HIV, they do pre-exposure prophylaxis, a preventive therapy that is a combination of two components. It should be taken daily while they have risky practices, for months or years and with medical follow-up sometimes monthly, at least quarterly. “They are generally very knowledgeable people in this sense.”

Emergency services detect possible infected people who come for other reasons and conduct serological tests on them.

“This prevention has been able to stop the spread of HIV, diagnose a case that is not known to be infected and, at the same time, detect and control other sexually transmitted diseases such as asymptomatic syphilis, chlamydia or gonorrhea. “It helps us control viral and bacterial venereal diseases,” added Dr. Dueñas. And now “the new trend is also ‘slam’, intravenous drugs that are also used for sex. With all these characteristics we offer preventive prophylaxis consultation in hospitals, smart and protective care. In Spain there are already 22,000 people who have followed these preventive therapies.

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And another program, this one promoted in hospital emergencies, which helps prevent disease, is the opportunistic analysis of cases that come to these services “for other reasons but with signs of HIV, a serology was done. For example, in a case of mononucleosis … well, we took the opportunity to do a test and the cases were found early, which allowed for more effective treatment and cutting the transmission,” said this internist.

AIDS is a chronic disease where survival is similar to that of the general population.

Another important development, but still a problem, is the reduction of the percentage of people who are infected and do not know it. They reached almost 18% and now the undiagnosed is only 7%. One percent also support these types of prevention programs. Much more needs to be learned to reduce the disease to a minimum. And the invisible group is getting smaller and smaller. If they arrive late, their body will be damaged and the treatment will be more complicated. It was noticed in time that they had a beautiful prognosis, with medicine,” said Dueñas.

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The future: semi-annual treatments and rechargeable patches

Transmission control – “I see more preventive patients than infected patients,” emphasizes Dueñas – and improve the dosage of drugs. This is the goal. “The drugs we need now to treat HIV are very good and, in many cases, they are not suitable for everyone, we inject them every two months and they don’t need to take the pill every day. Some are still doing it but it’s one, not twenty like before. And the future will go along these lines, in rechargeable patches, weekly oral therapies or semi-annual or annual treatments that give freedom to these patients and help them preserve their privacy. Now many retire and go to Benidorm for months and forgetting the medicine can be a success. Or if they work, the pills must always be taken at the same time time, and they don’t want to know it because it’s another stigmatizing disease, or they live in an apartment with friends and they don’t want it. it’s to know… The medicine like this that class is the quality of life for them,” Dueñas insisted.

Transmission has changed since the epidemic began (it was recognized in 1983) and in 1990. «Contagion from intravenous drugs has decreased, although we have more because it is an addiction that is maintained by people who come from the Eastern Europe. And even if there is a gathering between homosexuals and heterosexuals, the biggest stronghold of AIDS is the parties of sex and drugs and many men because they have intercourse between them which is more dangerous to be infected. “It’s almost a sexually transmitted disease.”