World AIDS Day 2025 : Connecting the Dots for HIV and Liver Health in Spain

On World AIDS Day, the Public Health Liver Group launches "A Plena Vista" campaign to raise awareness of steatotic liver disease among people living with HIV to support integrated care and promote long-term well-being and quality of life.

World AIDS Day is a time to recognise progress—and to draw attention to the blind spots that still shape the health of people living with HIV. Spain’s HIV system is one of the most robust in Europe: data collection is strong, retention in care is high, and the collaboration between clinicians, researchers, and community organisations has driven decades of achievement. Yet even within such a well-structured system, one of the most common comorbidities continues to remain largely unnoticed.

A Plena Vista, the Campaign Highlighting Liver Health in HIV

That’s why the Public Health Liver Group at ISGlobal has launched the campaign A Plena Vista (“In Full View” in Spanish) after a simple but critical realisation: in Spain, liver disease remains out of sight within HIV care, even though it is one of the leading comorbidities affecting people living with HIV. While HIV programmes have made extraordinary progress in managing coinfections such as hepatitis C, the next major challenge—steatotic liver disease, particularly its metabolic forms (MASLD/MASH)—is still not being diagnosed enough in most clinical settings.

This reflects a systemic gap: even the most advanced health systems can overlook what they do not routinely measure. And in health, as in art, what stays out of focus often falls out of care. A Plena Vista was created to bring liver health into sharp view in Spain.

The campaign takes inspiration from Las Meninas, chosen because it’s widely recognized by its Spanish audience—from the general public to clinicians and academia. Spanish artist Diego Velázquez shows the king only as a reflection: present, easily missed, and ultimately overlooked. 'A Plena Vista' uses this familiar metaphor to reflect a similar truth in HIV care in Spain—the liver is essential, and yet frequently overlooked.

Las Meninas. Velázquez, Diego Rodríguez de Silva. Image: ©Museo Nacional del Prado.

A major milestone came in October 2025, when the European AIDS Clinical Society (EACS) updated its guidelines to include, for the first time, a dedicated Diagnostic Flow-chart to Assess and Monitor Disease Severity in Suspected MASLD and Metabolic Risk Factors in people living with HIV. This new pathway offers clinicians a practical, evidence-based guide for integrating liver screening and non-invasive fibrosis assessment into routine HIV care—tools that the Spanish system is ready to adopt.

Spain has the tools; integration is still missing

The ISGlobal-led campaign underscores that Spain already possesses the infrastructure and expertise to monitor liver disease in HIV populations. What is missing is integration. The pieces exist, but they are not yet connected. By aligning HIV services with the new EACS recommendations, Spain can reduce missed opportunities for early diagnosis and ensure that liver health becomes a standard part of the HIV care continuum.

HIV care can no longer remain siloed. Liver disease in people living with HIV can be both infectious (such as HCV coinfection) and non-communicable (involving steatosis and metabolic dysfunction). Building on Spain’s leadership in viral hepatitis elimination, A Plena Vista invites the voices of hepatologists, HIV clinicians, NCD specialists, researchers, and community leaders to advocate for a coordinated response that reflects the dual infectious–metabolic nature of liver disease.

Emerging Spanish evidence shows that many comorbidities affecting quality of life are preventable when identified early

The campaign’s message is clear: preventive hepatology must be embedded in HIV care. Non-invasive fibrosis tools, metabolic assessments, and structured clinical pathways like the 2025 EACS flow-chart can be seamlessly integrated into routine monitoring. Emerging Spanish evidence shows that many comorbidities affecting quality of life are preventable when identified early.

This World AIDS Day, A Plena Vista invites Spain to bring into focus what has long remained unseen—and to transform visibility into action that strengthens the lifelong health of people living with HIV.