End inequalities. End AIDS.

01 December 2021

Set up in 1988 by the WHO, World AIDS Day was the first day dedicated to health around the world. Today, we speak to researchers and ”la Caixa” Foundation fellows Elisa López from ISGlobal and Ifeanyi Jude Ezeonwumelu from IrsiCaixa. Both of these centres are supported by the ”la Caixa” Foundation. 

Fairness and global responses

Before starting her university education, Elisa knew that she wanted to work in medicine with a social perspective. During her undergraduate studies, she got involved with cooperation and research projects in India, Cameroon, Morocco and Cambodia. She says that these experiences, along with her time at Harvard, where she did a Master in Public Health with the help of a fellowship from the ”la Caixa” Foundation, were what set the course for her career. 

Elisa López is a pediatrician and a researcher at ISGlobal, where they investigate tuberculosis/HIV coinfection in Mozambique.

Currently, Elisa is a pediatrician and a researcher at ISGlobal, where they investigate tuberculosis/HIV coinfection in Mozambique, specifically among the younger and vulnerable population. Her group is developing new tools to improve HIV diagnosis and treatment in sub-Saharan Africa, such as new tests to detect virological failures and to diagnose tuberculosis in co-infected individuals. These two infections, she explains, are not only difficult to eliminate because of the characteristics of the pathogens, but also because they are “clear examples of diseases caused by poverty.” “Place of birth can, without a shadow of a doubt, be a determining factor in the risk of HIV infection and developing tuberculosis, as well as the prognostic.”

Now, at a time when HIV has been around for 40 years, there are still huge inequalities in diagnosis and treatment for the virus that causes AIDS across different places in the world. Elisa gave us the example of the delay, lasting many years, between the discovery of combined antiretroviral medication and its generalised use. In 1997, the FDA (Food and Drug Administration) approved Combivir, the first combined antiretroviral pill. A decade later, coverage for the treatment in Sub-Saharan Africa was 28% in adults and 15% in children. “While wealthier countries use their health systems which allow them to provide personalised treatment, in most African countries, due to the lack of economic resources and the precariousness of the health systems, public health approaches focus on the population and not on the individual," adds the researcher.

Has the COVID-19 pandemic worsened existing inequalities? The opposite could have happened if we had finished assuming that epidemics have no borders, says Elisa. "The pandemic threatens to wipe out decades of progress. The truth is that what has happened in recent days with the appearance of the omicron strain and the measures imposed on countries in Southern Africa are just one more example that shows us that the wealthier countries have been acting immorally and still are,” she said in conclusion.

New strategies against HIV

Ifeanyi has always been particularly aware of this situation. His interest in HIV research dates back to her childhood in Nigeria, his home country. In Sub-Saharan Africa, the HIV rates are much higher than in the rest of the world and, unfortunately, the stigma against people who are living with HIV is still very common,” he said. “As a child, I always wondered why we still didn’t have a cure.”

Ifeanyi Jude Ezeonwumelu is doing his PhD at his lab at IrsiCaixa and IGTP with the support of an INPhINIT fellowship.

Even though the advances being made in the research have made the disease chronic rather than terminal, and people can live a normal life thanks to antiretroviral therapy (ART), there are still some weak points in this kind of treatment. “Chronic immune activation and persistent inflammation in HIV patients who are on ART are connected with hypercoagulation, fibrosis and tissue damage,” he said.

The fact that the disease doesn't have a cure yet is due to the dormant reserves of the virus, which remain in the cells and aren’t eliminated. “It is crucial to understand the mechanisms that govern latent HIV reserves if we are to develop strategies that attach and eliminate the viral reserves and cure HIV,” he added. Recently, at his lab at IrsiCaixa and IGTP in Badalona, where he is doing his PhD with the support of an INPhINIT fellowship, they have identified a group of compounds that can reverse HIV latency by modulating the innate immune system. “We hope that this will hold the key to reducing the size of the latent reserves,” he said.

Elisa and Ifeanyi both feel that a lot of advances have been made in recent years. Actually, “the swift development of COVID-19 vaccines is, in part, the result of the lessons we’ve learnt over four decades of trying to develop an HIV vaccine,” said Ifeanyi. We are getting ever closer to a cure for HIV, but we will only get there if we act fairly and in coordination. “It is crucial that we implement global measures to ensure that scientific advances also benefit those who need them most”, added Elisa. 

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