40 years of HIV

Abstract

December 1 is considered the World Day of the Fight against HIV, this day we remember an ailment that has been with us for forty years and that has killed 37.7 million people since 1981 (ONUSIDA, 2021). Currently more than 10 million HIV + people are still without treatment in Africa, Asia and Latin America; each year there are 1.5 million new HIV positive people and 680,000 people die from AIDS-related diseases (ONUSIDA, 2021). And yet HIV seems like a thing of the past; It is no longer a topic of conversation nor does it cause alarm, but it still kills. The fear has been lost and since you no longer die of this, many are late. Just today we are discovering the sequelae that it generates, for example, in the brain. It has been observed that around 30% of patients are prone to developing HIV-associated neurocognitive disorders (Clifford and Ances, 2013; Portilla et al., 2019). Although antiretroviral therapies have been a great advance in lowering the viral load in the blood, the same does not happen in the nervous system. Most drugs are not capable of crossing the blood-brain barrier, so the virus can continue to generate viral particles, which produces inflammatory processes and ultimately damage to neurons, which can generate disorders such as some types of dementia (Heaton et al., 2010). Since 1996, a new generation of more effective antiretrovirals has been developed. However, HIV has always been ahead of the immune system. It is a virus that produces very fast mutations, so much so that the virus in recent years is completely different from the one detected in 1981 (Zanini et al., 2017). This high mutation rate in the virus has been the main obstacle to an effective vaccine.

After 40 years, we keep asking ourselves: How did we end the pandemic? To begin with, we must diagnose 95% of cases early, treat them and continue treatment to present an undetectable viral load. That is the roadmap for 2030 according to ONUSIDA, the Joint United Nations Program on HIV / AIDS, created in 1994. Where the goal of treatment has been set to contribute to the end of this pandemic, known as 90-90- 90 (ONUSIDA, 2015). Its objective is that 90% of people living with HIV know their serological status, 90% of people diagnosed with HIV receive antiretrovirals and 90% of people receiving antiretrovirals have viral suppression (ONUSIDA, 2015). In 2020 only 73% of people living with HIV had access to treatment (ONUSIDA, 2021).
Today, anonymous HIV positive people have become viral bombs that are unknowingly spreading the pandemic and slowing its eradication. It is a risk that society does not perceive. But it is there. The later it is detected, the more viral load you have, the more altered your immune system will be. This knowledge must be spread and "viralized" so that it is understood. We do not get anything by living longer if the quality of life is not going to be good.