Collaborator: Dr. Ronald Collazo Pagán, MD Junio 2026
The decade between 1980 and 1990 represented a before-and-after in many doctors’ professional careers. The beginning of the AIDS epidemic in the U.S. caused a period of insecurity and uncertainty in the medical community. It was social commitment and moral responsibility that led many doctors to put aside their beliefs and safety to help a group of men and women marginalized by society.
The intervention of the primary care physician was, and continues to be, key to improving the way in which events that threaten the health of the population are responded to and currently handled. Even with advances in the diagnosis and treatment of HIV, the intervention of the primary care physician in the detection, management and prevention of this virus continues to be key.
HIV Today
According to the Puerto Rico Department of Health, between 1980 and 2022, there were 51,411 people reported to be diagnosed with HIV on the island. The Centers for Disease Control and Prevention (CDC) estimated that in 2023 in the U.S. and Puerto Rico, 1,132,739 people age 13 and older were living with an HIV diagnosis, with most being men. Most of these cases have been attributed to sex between men, and to a lesser extent, to injection drug use. Data reported by the Puerto Rico Department of Health’s Division of Epidemiology and Research reflect that in 2024, 22.7% of the diagnoses were in people over the age of 50. In this group, 3 out of 4 cases were men, with the main mode of transmission being unprotected heterosexual contact. It is currently estimated that in Puerto Rico, more than 50% of patients living with HIV are age 50 or older.
Detection, Treatment and Prevention
There are currently three main types of HIV tests:
HIV Antibody Test
HIV Antibodies
Blood, saliva or urine
23 days from the infection
It may take longer to detect a recent infection.
Antibody/Antigen (HIV) Test
HIV Antibodies and Antigens
Blood
Between 18 and 90 days
It’s the most common test.
Nucleic Acid (viral load) test
HIV Genetic Material (RNA)
Between 10 and 33 days
Detects infection earlier.
In patients who test negative for HIV, the CDC recommends assessing their needs and risk factors, and offering prevention tools such as pre-exposure prophylaxis (PrEP), using condoms, and risk reduction counseling. If the patient was exposed to HIV, is in the window period, and obtained a negative result, they should repeat the labs later to ensure it’s truly negative.
There is a post-exposure prophylaxis treatment known as PEP, which must be used within the first 72 hours after sexual exposure to HIV. After this period, it loses its effectiveness.
In patients with a positive HIV result, additional testing is recommended to determine the stage of the disease’s progression (acute HIV, asymptomatic HIV, and AIDS), and to choose the appropriate drugs, as needed. Recommended tests include:
Upon completion of the patient’s assessment, it’s advisable to start antiretroviral therapy (ART) as soon as possible. This is known as rapid initiation. And although this treatment does not cure HIV, it does improve the patient’s quality of life. In patients with an undetectable virus (viral load less than 200 copies), the risk of transmission is reduced, and the CDC has determined that undetectable is equivalent to untransmittable. Primary care for patients newly diagnosed with an HIV infection should include screening for opportunistic diseases and sexually transmitted infections, getting an annual tuberculin test, and updating their vaccination history at each visit.
It’s necessary to reinforce in patients the importance of adherence to the HIV treatment regimen. The risks of non-compliance with HIV therapy must be explained, such as reproduction of the virus, increased risk of developing drug resistance, therapeutic failure, and transmission to others. If the patient returns to continue treatment after not having been adherent, the person should be referred to an HIV specialist doctor to ensure that the treatment received is the most appropriate.
Advances in prevention, diagnosis and treatment have changed the landscape for HIV patients, allowing them to live long and healthy lives. The role of the primary care physician in HIV care has also evolved from one focused on diagnosis, the management of opportunistic infections and palliative care to a focus on healthy aging for the HIV patient. And while there’s still much to be done, the contribution of the primary care physician remains essential.
The goal remains to stop the HIV epidemic. With early diagnosis, timely treatments, and the provision of HIV prevention drugs (PrEP), we can reduce new cases until we reach zero transmissions.
