One step forwards and two steps back

So it seems that Bush and company have decided that they are no longer forcing much of their AIDs money to go into abstinence only campaigns. Instead they now require ‘justification’ if less than 50% of money doesn’t go into abstinence or faithfulness campaigns, which may sound reasonable but it will depend in my view on how stringent they are (and what conditions they stick on that). The ABC (Abstinence, Be faithful and use Condoms) campaign in Nigeria showed this can be a very effective approach, but preaching abstinence and faithfulness alone is utterly worthless for doing much of anything. If this is just another way of enforcing more money into going into campaigns that clearly don’t work well rather than sensible sexual education and prevention campaign (and that means encouraging things like condom use) then it’s just going to make things worse.

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Nature and HIV pessimism

This news article in Nature, entitled, HIV can ‘never be cured’ caught my interest pretty much immediately as it describes some interesting new research on the HIV virus and for its unusually pessimistic title. For one thing, it’s true that HIV is a very tricky virus to get rid of because it attacks the immune system that a vaccine and the host needs to actually destroy the virus to begin with. Additionally, as if things weren’t bad enough, HIV is pretty crafty and likes to hide in a wide variety of places such as inside T-cells (the generals of the immune system for a rough comparison), follicular dendritic cells (which store antigens for restimulating memory T-cells) and apparently even the gut (1). Being able to infect the gut causes a few problems, one of which is that the current top of the line anti-retroviral drugs don’t seem to be able to destroy this gut reservoir of HIV. This leads to a continual re-infection of the rest of the body from the HIV population in the guts lymphoid (immune) tissue.

While a serious problem, I don’t view this as making HIV ‘incurable’ by any stretch, just it makes things considerably more complicated. It should mean rather than being a result that makes us more pessimistic, instead it should be taken as a result that bolsters our understanding of how HIV causes an infection and better design a vaccine/new drug regimen. For example, armed with this knowledge a potential vaccine may have aspects that help target mucosal immunity and could [theoretically] inspire the gastrointestinal part of the immune system to help destroy the virus: or even prevent the early reservoir from being able to form abrogating an infection. Likewise, current anti-retroviral treatments could have new drugs or altered existing drugs that can target the virus in the gut lymphoid tissue, helping to further prevent reinfection with the virus.

It should be conceded that HIV being able to form a relatively protected reservoir in the gut does make life a whole lot more difficult, I don’t think it’s a result that warrants undue pessimism by any stretch. Knowing something you didn’t know before and couldn’t account for, doesn’t make HIV any more ‘incurable’ than it was before, instead it should be taken as a new way of thinking and attacking the problem at hand. Statements like declaring it ‘incurable’ are not going to help anyone anytime soon.

1) Chun, T.-W. et al. J. Infect. Dis. doi:10.1086/527324 (2007).

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