About AIDS-HIV treatments
There is no doubt that HIV antiviral treatment is one of the major advances in medicine in the last 25 years. However, despite its prolonged use, the medication does not cure the infection. This is demonstrated by several facts: the detection of viral DNA and RNA in the cells of the huge majority of patients treated; the possibility of rescuing virus with replication capacity after ex vivo stimulation of lymphocytes in their blood; the persistence of residual viraemia (fewer than 50 copies of viral RNA per millilitre of blood) in most patients; the presence of the microorganism in secondary lymphatic tissues despite the medication; and the almost universal reappearance of the virus in the blood of those who abandon treatment.
Therefore, although antiretrovirals stop HIV replicating, they do not cure the infection, leading to an increase in the number of persons living with the virus. This poses new challenges regarding the long-term clinical effects of treatment. Although the mortality in HIV-positive individuals continues to fall as treatments become better, there are still negative side effects. For example, the incidence of neoplasia, liver, cardiovascular and neurocognitive diseases and loss of bone mass in patients treated with antiretrovirals is higher than that in the general population, especially when the CD4+ T lymphocyte count is low.
Moreover, new infections need to be curbed urgently, since, for every infected person who starts treatment, there are two new HIV infections. Stigma and discrimination, which remain despite access to therapy, must also be prevented. There is however, another even more important aspect: As the treatment is lifelong, patient compliance is not easy. Added to this are possible toxicity and a high long-term economic cost, which limits universal access to therapy. Consequently, the development of strategies that seek sustained viral remission after a period of treatment would provide major individual, global and economic benefits (Javier Martínez-Picado, Investigación y Ciencia, July 2013; Fragment).