AIDS Clinical Research in Spain—Large HIV Population, Geniality of Doctors, and Missing Opportunities

Abstract

The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.

Trends in hospitalizations and deaths in HIV-infected patients in Spain over two decades

“…In Spain, HIV widely spread during the 80s and 90s, largely driven by an epidemic of injection drug use [10], which fortunately declined thereafter [11]. Current estimates are of 150 000 PWH and roughly 60 000 cumulative deaths since the beginning of the AIDS pandemic [12,13]. Herein, we examined the clinical burden and time trends in PWH hospitalized in Spain during the last two decades.…”

The slowdown of new infections by human retroviruses has reached a plateau in Spain

“…The slowdown in reduced yearly infections for HIV‐1 in Spain points out that new strategies are needed to achieve the United Nations 95‐95‐95 targets by 2025 42 . The elimination of HIV‐1 and the remaining neglected human retroviruses may be pushed forward by four interventions: (1) expanding testing; (2) improving education and interventions aimed to reduce risk behaviors 43 ; (3) facilitating access to antiretrovirals as treatment and prevention, and pushing further development of long‐acting formulations 44,45 ; and (4) increasing vaccine research efforts, especially for HIV‐1 and HTLV‐1.…”

The Epidemiology of the AIDS Pandemic

“…Some sources disagree on the exact year that HIV arrived in Spain. One states that the first infection was in 1981 (Allbritton, 2016), while another states that the first infection was in 1982 (Soriano, Ramos, Barreiro, Fernandez-Montero, 2018). Due to the disagreement of the dates for the first infection in Spain, and our inability to track down a primary source stating the first HIV infection in Spain, it is difficult to conclude if the U.K. or Spain had the disease first.…”