HIV, new objectives and a story of hope

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02/12/2021

HIV, new objectives and a story of hope

This year marks 40 years since the first case of AIDS in Spain and, since then, HIV research has gone from offering quality of life to eradicating the disease, one of the objectives pursued by IrsiCaixa

Forty years ago I had the opportunity to visit, together with the dermatologist Caterina Mieras, a patient who was being treated by Dr. Jaume Vilaseca's team at the Vall d'Hebron Hospital and who had skin lesions caused by Kaposi sarcoma. At that time, I was not aware that the 35-year-old man in front of me would end up becoming the first case of AIDS diagnosed in Spain, and even less conscious that, from this disease, I would build one of the most important lines of research in my scientific career. After that first case came others, many others. They all followed the same pattern of symptoms, which ended up under the name Acquired Immune Deficiency Syndrome (AIDS). It was clear that it was an infectious disease and, in 1983, the team of Françoise Barré-Sinoussi and Luc Montaigner discovered the causative agent: the Human Immunodeficiency Virus (HIV).

The fact that HIV is one of the most complex viruses in existence is due to its high capacity to mutate. Imagine that HIV is a microscopic green ball and that, when it infects us, our defences are able to generate, within days, an effective response to fight it. Now imagine that this tiny ball changes colour every time it infects a cell. This means that, within a single organism, balls of thousands of colours will appear at breakneck speed. What used to be a one-on-one fight becomes a fight at a disadvantage. It is impossible for our defences to produce an effective response in time against the whole range of colours and this means that we are always one step behind; when the virus mutates and changes colour, the defences are still generating the response against the previous version of the virus.

Epidemics are almost always caused by zoonoses. HIV is one of the examples, as it passed from chimpanzee to human around the 1920s, when poachers in the Belgian Congo –today's Democratic Republic of Congo– became infected by coming into contact with the blood of these primates while killing them. Subsequently, migration from rural areas to large cities and, probably, vaccination campaigns using non-disposable needles, along with sexual transmission, led to an increase in infections.

AIDS was a terrible disease in its early days, a death sentence one or two years after diagnosis. All we could offer was quality of life during that period of time. Later, from 1987 onwards, the first drugs were tested, but they gave very short-lived results. It was not until 1995 that combined therapies were discovered, a strategy that has allowed the disease to be chronified but which, at that time, involved administering a cocktail of drugs that generated a lot of toxicity. Gradually, this type of therapy has been simplified and now consists of a single daily tablet with no side effects. In fact, work is being done to design monthly or even biannual treatments. This has made it possible to bring the quality of life and life expectancy of people living with HIV up to par with that of other people. In fact, when treatment is followed correctly, HIV remains undetectable in the blood and this means that the person cannot transmit the virus on any occasion, neither through risky practices nor by having progeny. This is a key point. All people infected with the virus must be detected and treated with effective therapies. However, it is imperative that this is applied worldwide, without exception.

At the research level, the focus on HIV has changed radically. We have been able to shift all our efforts to eradicating the disease. This is the goal that we pursue at IrsiCaixa, the first Catalan laboratory dedicated to HIV, which was created more than 25 years ago thanks to the support of the "la Caixa" Foundation and the Department of Health of the Generalitat de Catalunya. The main obstacle to eradicating HIV is the viral reservoir, a remnant of the virus that remains hidden inside some cells of the immune system. To eliminate this dormant virus, it will be necessary to combine therapeutic vaccines that re-educate the immune system to control HIV with drugs that force the virus out of hiding, as well as laboratory-designed neutralising antibodies and specific immunoglobulins.

However, the achievement of all these objectives is only feasible with funding. Much of the work carried out at IrsiCaixa has been possible thanks to the support of the Catalan pharmaceutical company Grifols, as well as grants from foundations such as Sorigué and Glòria Soler, and the #YoMeCorono sponsorship campaign. If no money is invested in research, we will always be victims of new diseases. And not only in human health research, but also in animal and environmental health. In our country, there is a lot of talent, but we need to offer it tools and support it in a clear and efficient way.

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