The dangerous evolution of HIV Edsel Salvaa
The Philippines: an idyllic country
with some of the clearest water
and bluest skies on the planet.
It is also the epicenter
of one of the fastest-growing
HIV epidemics in the world.
On the surface, it seems
as if we are just a late bloomer.
However, the reasons
for our current epidemic
are much more complicated
and may foreshadow
a global resurgence of HIV.
While overall new cases of HIV
continue to drop in the world,
this trend may be short-lived
when the next wave of more aggressive
and resistant viruses arrive.
HIV has a potential to transform itself
into a new and different virus
every time it infects a cell.
Despite the remarkable progress
we’ve made in reversing the epidemic,
the truth is that we are just a few
viral mutations away from disaster.
To appreciate the profound way
in which HIV transforms itself
every time it reproduces,
let’s make a genetic comparison.
If we look at the DNA variation
among humans of different races
from different continents,
the actual DNA difference
is only 0.1 percent.
If we look at the genetic difference
between humans, great apes,
and rhesus macaques,
that number is seven percent.
In contrast, the genetic difference
between HIV subtypes
from different patients
may be as much as 35 percent.
Within a person infected with HIV,
the genetic difference
between an infecting mother virus
and subsequent daughter viruses
has been shown to be
as much as five percent.
This is the equivalent of a gorilla
giving birth to a chimpanzee,
then to an orangutan,
then to a baboon,
then to any random great ape
within its lifetime.
There are nearly 100 subtypes of HIV,
with new subtypes
being discovered regularly.
HIV in the developed world
is almost all of one subtype:
subtype B.
Mostly everything we know
and do to treat HIV
is based on studies on subtype B,
even though it only
accounts for 12 percent
of the total number
of cases of HIV in the world.
But because of the profound
genetic difference
among different subtypes,
some subtypes are more likely
to become drug-resistant
or progress to AIDS faster.
We discovered that the explosion
of HIV cases in the Philippines
is due to a shift
from the Western subtype B
to a more aggressive
Southeast Asian subtype AE.
We are seeing younger and sicker patients
with high rates of drug resistance.
Initial encroachment of this subtype
is already occurring
in developed countries,
including Australia,
Canada and the United States.
We may soon see a similar
explosion of cases in these countries.
And while we think that HIV is done
and that the tide has turned for it,
just like with real tides,
it can come right back.
In the early 1960s,
malaria was on the ropes.
As the number of cases dropped,
people and governments
stopped paying attention.
The result was a deadly resurgence
of drug-resistant malaria.
We need to think of HIV
not as a single virus
that we think we’ve figured out,
but as a collection of rapidly evolving
and highly unique viruses,
each of which can set off
the next deadly epidemic.
We are incorporating
more powerful and new tools
to help us detect
the next deadly HIV strain,
and this needs to go hand in hand
with urgent research
on the behavior and proper treatment
of non-B subtypes.
We need to convince our governments
and our funding agencies
that HIV is not yet done.
Over 35 million people have died of HIV.
We are on the verge
of an AIDS-free generation.
We need to pay attention.
We need to remain vigilant
and follow through.
Otherwise, millions more will die.
Thank you.
(Applause)