Loading ...

The Pan American Health Organization (PAHO) said that reducing deaths associated with advanced HIV disease in Latin America will require more locally driven research to support interventions targeting opportunistic infections, strengthen health systems, and improve outcomes among populations at the highest risk.

These priorities emerged from a recent study published in the Journal of the International AIDS Society, which involved experts from multiple countries across the region. The findings come amid ongoing concerns that despite progress in HIV prevention and treatment, Latin America has not reduced HIV-related mortality at the same pace as other regions. Globally, HIV-related mortality has declined by 50% since 2010 compared with a 28% reduction in Latin America.

Speaking with Medscape’s Spanish edition, Omar Sued, MD, infectious disease specialist and regional adviser at PAHO for HIV and sexually transmitted infection treatment and care in Washington, DC, said, “The study arose precisely from the need to listen to those on the front lines of the response: clinicians, researchers, program leaders, and academics from across the region.”

Sued said that the effort was designed not to replicate global priorities but to identify the research questions that truly matter in Latin America, where late diagnoses, treatment interruptions, and profound social inequalities continue to pose major challenges.

“We cannot move toward eliminating HIV as a public health problem if we continue to rely exclusively on research agendas that do not always reflect our epidemiologic, economic, and social realities,” he said.

The study reviewed systematic reviews published during the past decade and relied on expert input gathered through a series of meetings involving healthcare professionals from 17 countries across the region. Through this process, researchers identified 77 high-priority research questions, including 60 focused on adults and 17 involving pediatric populations.

Opportunistic infections are a major area of concern, with tuberculosis being the most cited condition, followed by cryptococcosis, histoplasmosis, and neoplasms. Interventions aimed at reducing late diagnosis, improving retention in care, and strengthening health systems also attracted considerable interest, particularly those targeting vulnerable populations such as children, pregnant women, and incarcerated individuals.

Sued described the study as a highly informative, complex, and rewarding experience that helped clarify both the urgent challenges and opportunities facing the region.

He said that the discussions reinforced an urgent concern: Many individuals continue to enter the healthcare system with severe immunosuppression, preventable opportunistic infections, and a high risk for avoidable death.

He added that the study also highlighted the region’s substantial capacity to address the problem through integrated health systems, highly experienced researchers, respected institutions, and a broad technical consensus on what should be studied, where efforts should be concentrated, and how outcomes can be improved.

Common Priorities

Jimena López Piñeiro, infectious disease specialist and HIV care expert at Hospital de Infecciosas Dr Francisco Javier Muñiz in Buenos Aires, Argentina, who was not involved in the study, said the findings are “extremely relevant for Latin America because they reflect a problem that remains a daily reality in our clinical practice: Many individuals continue to present with advanced disease and preventable complications.”

“The value of the study lies in the fact that it focuses not only on opportunistic infections but also on the structural shortcomings of our healthcare systems. In our region, particularly in Argentina, marked social inequalities persist, along with barriers to accessing the public healthcare system and a lack of sustained public education about HIV,” she added.

Overall, López Piñeiro agreed with the priorities found in the study, particularly those related to diagnosing opportunistic infections and improving retention in care.

However, she noted that research gaps remain on barriers that occur before diagnosis, including difficulties accessing care, lack of sustained awareness campaigns, stigma, and gaps in sex education and medical training.

She also emphasized the importance of evaluating active case-finding strategies and decentralized screening programs in community, educational, and workplace settings so that access to diagnosis does not depend solely on patients presenting to hospitals.

“I believe we also need to place greater emphasis on the community perspective when establishing research priorities. Community organizations and individuals living with HIV should not participate solely as recipients of health policies but also as active partners in designing prevention, testing, access, and continuity of care strategies,” López Piñeiro said.

She added that “in Latin America, much of the work involved in supporting individuals and linking them to the healthcare system falls to civil society organizations.”

Advanced HIV disease is still a frequent cause of mortality in Latin America and is closely linked to late diagnosis, which accounts for 30%-39% of new HIV cases in the region, treatment gaps, and structural barriers, particularly among key populations and other vulnerable groups.

Sued said that although contextual differences exist among countries, the priorities for advancing research in this area are broadly similar across the region.

“There are very clear common challenges: Late diagnosis continues to affect approximately one third of individuals with HIV, limitations persist in the management of advanced disease because certain supplies are not consistently available, and the most common opportunistic infections, such as tuberculosis, histoplasmosis, and cryptococcosis, remain a regional problem,” he said.

He added that Latin America shares a need to strengthen retention in care through strategies that enable healthcare teams to reconnect with individuals who discontinue follow-up, support adherence to prolonged treatments such as tuberculosis therapy, and promote preventive measures.

Simultaneously, he noted that some challenges are more context-specific, particularly in pediatrics and among highly vulnerable populations, including migrants, individuals experiencing homelessness, and those living in remote Indigenous and rural communities, all of which require approaches tailored to their circumstances.

López Piñeiro agreed that common research challenges exist across Latin America, while noting that priorities may differ according to available resources and the organization of individual healthcare systems.

“Even within Argentina, not all provinces have the same diagnostic tools or equal access to specialized care. In addition, social vulnerabilities such as problematic substance use, economic instability, or a lack of housing resources often make it difficult to maintain continuity of care,” she said.

Regional Collaboration

The study outlined a comprehensive research agenda and provided a roadmap for improving HIV-related outcomes and reducing mortality. However, the authors emphasized that translating research findings into concrete policies and interventions will require stronger regional collaboration and greater political commitment across countries.

“HIV recognizes no geographic boundaries, either within or between countries. That is why consensus and regional collaboration are essential to reducing mortality and moving toward the elimination of HIV as a public health problem,” Sued said.

To support that goal, PAHO promotes research protocols, facilitates the exchange of data and experiences through technical cooperation networks, and helps standardize definitions and interventions through treatment guidelines.

The organization also works to expand access throughout the region to essential tools for managing advanced disease, including rapid tests for histoplasmosis and cryptococcosis, and medications such as liposomal amphotericin B and flucytosine, which remain difficult to access in some countries.

Sued noted that PAHO has already completed epidemiologic surveillance frameworks for advanced HIV disease, generic protocols for mortality analyses, minimally invasive autopsy protocols for patients who die with HIV but have no identified cause of death, and prevalence study protocols for histoplasmosis, cryptococcosis, and tuberculosis.

In 2026, the organization plans to expand tuberculosis prophylaxis among individuals with HIV through greater use of shorter, more accessible regimens based on rifapentine and isoniazid. It also plans to conduct country assessments across the region using a standardized methodology known as the “pathway to elimination.”

“We will present much of this work at the upcoming International AIDS Conference (AIDS 2026), which will take place in July in Rio de Janeiro, Brazil, where we will present seven studies conducted in countries across the region,” Sued said.

López Piñeiro agreed that regional research collaboration is essential because it enables countries to generate their own evidence, share strategies adapted to comparable settings, and strengthen multicenter research efforts.

She also emphasized that greater political commitment and sustained funding are necessary if research is to translate into concrete actions, including expanded access to diagnosis, decentralized care, and stronger connections between healthcare systems and underserved populations.

“It is not enough simply to guarantee access to antiretroviral treatment. We also need public policies focused on prevention, education, early diagnosis, and strengthening of the public healthcare system. In addition, ongoing training for primary care professionals is essential because many opportunities for diagnosis are still missed during initial consultations,” López Piñeiro said.

Sued noted that more than 90% of the HIV response in Latin America is funded by governments in the region, which he said reflects a strong commitment despite the many competing healthcare demands. He added that the availability of highly effective tools, including rapid tests, preexposure prophylaxis, and antiretroviral therapy, can create the impression that HIV is a solved problem even though important challenges persist.

“Every funded study, every piece of data generated, and every evidence-based policy is lives saved and healthier societies. Our region has resources, knowledge, talent, and experience. We have already shown this by eliminating mother-to-child HIV transmission in 12 countries. Now we need to align political will with that evidence for all generations and all countries,” Sued concluded.

Sued and López Piñeiro reported having no relevant conflicts of interest.

This story was translated from Medscape’s Spanish edition.