August 4, 2008
August 4, 2008 -- Currently, different surgical techniques have proven to be effective in the treatment of facial lipoatrophy (the loss of facial fat), one of the metabolic side effects that increases the sense of stigma among patients living with HIV who receive antiretroviral treatment.
To address this situation and improve the patient's life quality, the Spanish Minister of Health and Consumer Affairs, Bernat Soria, announced the future addition of treatment for this condition to the common services portfolio of the National Health System. The announcement was made at a meeting with NGOs and civil society during the XVII International AIDS Conference (AIDS 2008) in Mexico.
Lipoatrophy may also affect the limbs, and it is part of a larger syndrome known as lipodistrophy, which includes lipohypertrophy (the fat accretion in the abdominal cavity, mammary glands and cervical-dorsal region). According to data provided by the Metabolic Alterations Study Group (GEAM), the current prevalence of lipodistrophy in Spain is around 30.7% among people living with HIV. Out of this group, 60% (i.e. a total of 18.42%) are eligible for lipoatrophy treatment, resulting in approximately 14,000 patients with different intervention possibilities.
A report from the Secretary for the National AIDS Plan examines the psychological and treatment adherence implications related to lipoatrophy, and encouraged the search for solutions for those affected by this condition. Among the measures adopted was the delivery of surgical treatment by AIDS programs in some Autonomous Communities. Therefore, lipoatrophy surgery has been progressively included in the health services of the following Autonomous Communities: Andaluca, CastillaLa Mancha, Catalunia, Comunidad Valenciana, Extremadura, Madrid and Pais Vasco.
Equality in Service Delivery
In that context and within the scope of the Ministry's policies against stigmatization and discrimination, the incorporation of a lipoatrophy repairing treatment into the common services portfolio of the National Health System will ensure equal access to treatment for every patient in need.
In September, the General Assembly of the NHS Interterritorial Council will analyze the utility of implementing this intervention in reference units and services accredited by the Ministry of Health and Consumer Affairs, to ensure the use of the most experienced and qualified teams, as well as to ensure the quality of the services provided.
During his informal meeting with the NGOs at the conference, Soria expressed his personal gratitude for their commitment to protecting the human rights and civil liberties for people living with HIV/AIDS. The Minister of Health and Consumer Affairs recognized that their role as guardians of equal rights has been fundamental for the achievements in this field.
Harm Reduction, A Key Prevention Tool
Minister Soria also explained his Office's policies to fight the epidemic, and its commitment to sustaining and intensifying prevention policies. Consequently, the Minister explained the Spanish government's actions on implementation of harm reduction programmess, which he considers key factors in Spain's recent success in controlling the epidemic. "Our intention is not to change people's sexual behaviour or choices, but to reduce the risk and offer solutions according to their reality, which can be accepted by most vulnerable groups", Soria said.
The Minister also emphasized Spain's policies in other priority areas, such as free and universal access to preventive measures and treatments; fighting discrimination and stigma through specific programmess for gender inequity; and protecting human rights.
The conference includes a broad Spanish presence in the fields of HIV/AIDS prevention, control and treatment; antiretroviral resistance; AIDS epidemiology in hard-to-reach-areas; and international cooperation.
The results from the FIPSE cohort of people with HIV who have received liver transplants were also presented. This pioneering research was also carried out in the United States and France. The research aimed to create a national cohort of HIV patients who received liver transplants, which is now a key world-wide reference in terms of the number of cases included. To date, 18 liver transplant units within the National Health System are part of this study. They have conducted 140 transplants in HIV patients, with a survival rate of one, two or three years, similar to non-HIV patients who have had a transplant.
Today, there are between 120,000 and 150,000 persons living with HIV in Spain. Approximately 50% of them are co-infected with Hepatitis C virus (HCV), and approximately 7% are co-infected with Hepatitis B virus (HBV). In 2008, this research cohort was included in the HIV bio-bank of the National Health System, which aims to contribute to the development of a comprehensive scientific database of HIV infection. Currently, this bio-bank receives samples from 28 hospitals in the National Health System located all over Spain, which are participating in six cohorts of targeted patients. Clinic and demographic data associated with these samples are encoded for confidentiality.
The hepatic transplant study has a budget of 571,000 Euros for 2005-2008, and is entirely funded by the Fundación para la Prevención del Sida en España (FIPSE), a public-private initiative between the Ministry and the pharmaceutical industry, in line with recommendations made by UNAIDS to join public and private resources in the fight against HIV/AIDS.
Spain's Contribution to International Investment
As the Minister recalled during his participation in the plenary session, Spain has made a remarkable financial effort to cooperate with international organizations in the last years, which "places us on the right path to meet the goal of 0.7% by 2012. However, in spite of the progress achieved almost everywhere, due to unprecedented investments made to date, the United Nation's last report states that the epidemic is spreading faster than service delivery." Minister Soria has stressed this fact and requested more resources and prevention of new infections "to reduce the increasing gap between needs and available resources".
The conference also provided a platform to announce the next Spanish contribution of new funds to the international vaccine partnership against AIDS (3 million Euros), and to the international association of microbicides (1.5 million Euros), included in the 10.2 million Euros item assigned to UNAIDS.