On June 2, the first gala will be held at the Museu Nacional d’Art de Catalunya (MNAC) People in Red ‘postcovid’. The objective of the event is, one more year, to collect funds for the HIV/AIDS research. The most visible face of the gala is the doctor Bonaventura Clotet (Barcelona, 1953), Head of the Infectious Diseases Service at the Germans Trias i Pujol Hospital (Can Ruti, Badalona), director of the IrsiCaixa AIDS Research Institute and founder of the Fundació Lluita Contra la Sida, which will now be called Lluita Foundation Against Infections.
The People in Red gala returns.
The gala will have a very special point: Serrat, whom I have the pleasure of meeting and with whom I have been friends for years, has decided to perform in it the year of his farewell from the stage. He himself said that he wanted to help us in the investigation, and I am very grateful to him. We always did it in December, coinciding with World AIDS Day [el 1 de diciembre]but this year we moved it to the summer due to the epidemiological situation that existed at the end of last year with the sixth wave.
In addition, the Fundació Lluita Contra la Sida will no longer be called that.
-Yes, it coincides with a change of brand of the foundation. It was created 30 years ago and is now renamed the Fundació Lluita Contra les Infeccions. It makes sense because all the knowledge generated around AIDS has made it possible for us to make great strides in the fight against other infections.
Against covid, for example?
For example. But AIDS has also taught us about bacteria that are multi-resistant to antibiotics or about infections in immunosuppressed people. We have seen that multiresistant bacteria can often be cured with a fecal transplant. Given the range of diseases to which we are dedicated -which are all infections-, given all this diversity in research, it did not make sense for the entity to continue being called Fundació de Lluita Contra la Sida.
“It didn’t make sense for the foundation to be called Lluita Contra la Sida because we investigate many infections”
And, specifically, what has AIDS taught us about covid?AIDS was a highly stigmatized disease, and still is. In this sense, the contribution we made from the foundation and also from IrsiCaixa was very important. Research in the field of AIDS taught us about drug development, the role of the immune system in infections, the importance of early detection of the immune response, which part of it played a more important role in protecting infected people . Starting with AIDS, we have been advancing in other diseases such as the Ebola virus, the respiratory syncytial virus (RSV), in diseases related to aging -since AIDS accelerates aging, the so-called immunosenescence-. We also learned the role played by the microbiota, which are the millions of bacteria in the intestine and which play an important role in the immune response. Thanks to AIDS, a lot was learned and that is why the galas we did were very important, since they allowed us to raise money to start research immediately. Now, for example, we need money to continue studies with a cohort called ‘#coronavis’, which seeks to know the duration of the effectiveness of vaccines in people over 65 years of age.
It is not yet known how many times the elderly will have to be vaccinated.
Exactly, and it is essential. We must bear in mind that the vaccine is very effective, but that we also have drugs that, if administered in the first days of infection, reduce the progression of covid-19 by 85%. They are paxlovid, remdesivir and neutralizing antibodies. But, I insist, it is important to investigate what are the parameters that indicate that a person over 60 or 65 years of age may have a poor progression or not despite being vaccinated. The ideal is to find vaccines that are sterilizing [las que impiden el contagio]because the vaccine now does not prevent infection, but serious disease.
You recently warned that since omicron causes essentially mild illness, it does not generate many antibodies. How many people will be reinfected in this wave?
I have several cases that have been reinfected with omicron after four months. There is another issue, which is immunosenescence, the aging of the immune system. It begins beyond the age of 50 and causes the immune response to disappear earlier. Little was known about this, but thanks to the research carried out by IrsiCaixa, from the group of Marta Massanella, Julià Blanco and Julia García, it was shown that yes, that [la inmunidad se pierde] is lost. So we must be prepared to revaccinate more times, although we have to see which revaccinations are the most optimal. It seems that the vaccines that also incorporate the omicron variant are not the ones that would protect the most, but those that include the beta and Wuhan variants are.
“The key is to find out how long immunity from vaccines lasts, especially in the elderly”
Because right now everything indicates that we will be vaccinated several times a year.
Yes, but you have to know how often you have to be vaccinated, what is the most optimal combination of vaccines, what should be included to be more effective against all variants. And that needs research, and research needs money. There is a lot of talent in Catalonia and Spain, but we need the research centers to have money. Now, the group led by Nuria Izquierdo and Julià Blanco, at IrsiCaixa, has compared rapid antigen tests and has seen that they detect omicron very well. We did not know if they were effective for the omicron and research has shown us that they are.
When does the ómicron infected test positive?
With the new variants that are circulating, the antigens are positive on the fourth day after having the first symptom.
Back to AIDS. Why can’t we find the vaccine? It always seems that we are very close.
The AIDS virus has a very high capacity to mutate, which is why designing a vaccine that covers all the variants is very difficult. Although a preventive vaccine is being developed, results are not yet available. The immune system is always one step behind, it takes time to develop the response of neutralizing antibodies and cellular immunity. And when it does, the particles have changed. But the most important challenge is the eradication of the disease, which is already chronic, something difficult because the virus hides in some cells, which are the CD4 lymphocytes, but in a very low percentage of them, less than 1%. That’s why they have to be identified and destroyed, and that’s not easy because to do this you have to reactivate this virus that is inside these apparently normal cells. And, once the virus is out, many mutant viruses can appear, and there you have to have some antibodies that block them and a cellular immunity generated by a therapeutic vaccine that has educated the immune system to recognize viral mutants. It’s not easy. Right now only three people in the world have been cured of AIDS through bone marrow transplants, but that cannot be done because it has a higher risk than the correct antiviral treatment.
“The mask must be kept indoors and in closed spaces”
Do you already notice the rise in income due to covid?
The truth is that yes, there is more income, although it is also true that there is no significant increase in the ucis. But we must monitor the immunity generated by vaccines, which we know is waning. Neutralizing antibodies in vaccinated people drop sharply at six months and more in older people. So, if we don’t go on revaccinating, there will be a significant reduction in antibodies. There are still deaths from covid-19, there are still admissions to the ucis. Masks must continue to be used indoors, in closed spaces: they serve to prevent infections and reinfections.
It seems that we will finish all the year with a fourth dose of the vaccine, not?
-Yes it looks like yes.
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And will we see more pandemics?
-Yes; in fact, there are already many. Research should focus on the ‘One Health’ concept [una sola salud: la humana, la animal, la medioambiental]. Globalization and the warming of the Planet will cause desertification zones, which will cause viruses to jump from animals to humans: it is the so-called zoonosis. The animals are not treated correctly, they are overcrowded, and thus infections jump. Denmark had to cull an entire mink farm that had been infected with a variant of covid-19. If we don’t take all these things into account, there will be more zoonoses. In 2002 we had SARS-CoV-1; in 2003, the MERS; and in 2019, SARS-CoV-2. They are viruses present in intermediate animals, many of them in bats. If money had been allocated to research in the first SARS-CoV-1 outbreak, we would now have an effective vaccine that would have prevented us from this entire pandemic. It is a pity that governments do not learn that research creates jobs, creates patents, creates companies. It is the easiest way out of a crisis in the medium term and helps prevent infections that have economic repercussions, such as covid-19.