"Four decades of HIV: advances in treatment and the fight against stigma"

Over more than four decades since the identification of the first case of HIV, we have witnessed remarkable progress in the understanding and management of this disease. Currently, nearly 40 million people live with HIV worldwide, an alarming number that, however, contrasts with the achievements in treatment and prevention that have been reached in recent years. The history of HIV is an evocative mix of challenge, resilience, and progress, still facing the fight against stigma and misinformation. HIV, or human immunodeficiency virus, is a pathogen that attacks the immune system, specifically the T lymphocytes, the cells that fight infections. Without proper treatment, the virus can destroy these cells, leading to increased vulnerability to severe diseases and even the development of AIDS, the most advanced stage of the disease. Despite its devastating impact, knowledge about how it spreads and how to prevent its transmission has significantly improved. The transmission of the virus occurs through direct contact with the bodily fluids of an infected person, although it is more common in the early stages of infection. The World Health Organization (WHO) emphasizes that many people are unaware that they are infected until the disease has progressed, making early detection crucial. For this, there are tests that allow a person to know their HIV status, and the only way to obtain an accurate diagnosis is through these tests. The symptoms of HIV vary according to the phase of the disease, which is divided into three stages: acute, chronic, and AIDS. In the acute phase, which generally occurs in the first weeks after infection, the symptoms may resemble those of the flu. In the chronic phase, symptoms may be less evident, and without treatment, they can lead to significant health deterioration. Finally, AIDS manifests with opportunistic infections and severe diseases that can threaten life. It is essential to highlight that, although there is no cure for HIV, antiretroviral treatments (ART) have revolutionized medical care for infected individuals. These treatments stop the replication of the virus and allow people to maintain a quality of life similar to that of those who are not infected. This advancement has made HIV considered a chronic disease, and the mortality rate has significantly decreased in regions such as Latin America. The viral load in the blood of a person with HIV can become undetectable thanks to treatment, which greatly reduces the risk of transmission to others. This has been a key change in how the disease is addressed, emphasizing the importance of treatment adherence and access to medical care. In this sense, education and awareness play a crucial role in combating the stigma associated with HIV. Prevention is equally important, and an effective tool in this area is pre-exposure prophylaxis (PrEP). This medication, intended for individuals at risk of contracting HIV, is administered to prevent infection and is more effective when taken consistently. With the availability of PrEP options, including a long-acting injection, opportunities to protect those at higher risk are expanded. Recently, a significant step has been taken in the fight against HIV with the discovery of lenacapavir, an antiviral that is not only used as treatment but can also act as prophylaxis. Although it is not a vaccine, this advancement represents an important milestone in the search for innovative solutions to combat the epidemic. Despite the progress made in the treatment and prevention of HIV, it is essential to persist in education and research. There is still much to be done to eliminate stigma and ensure that all individuals have access to the care and support they need. The fight against HIV is a collective effort that requires the collaboration of society as a whole to continue moving toward a future where HIV is not only controlled but eliminated as a threat to public health.