ABOUT THE SPEAKER
Edsel Salvaña - Infectious disease specialist, molecular epidemiologist
TED Fellow Edsel Salvaña studies the genetics of HIV, and he worries that we are just a few mutations away from the next deadly pandemic.

Why you should listen

Dr. Edsel Salvaña discovered that the driving force behind a new AIDS epidemic in the Philippines is the entry and spread of a deadlier strain of HIV -- a situation that can easily occur anywhere in the world.

Salvaña is an infectious disease specialist, molecular epidemiologist and is the director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines in Manila. He is using next-generation sequencing and other cutting-edge genetic tools to study HIV viral diversity and superinfection. He is looking at how HIV develops drug resistance to better understand why his country suddenly has the fastest growing HIV epidemic in Asia; and why HIV treatment that works well in developed countries is failing on emerging HIV strains in the Philippines and resource-limited settings. He trains doctors in infectious diseases, and supervises the care of several thousand HIV patients at the Philippine General Hospital. He has been a national force in the formulation of HIV treatment guidelines, campaigning against stigma, and raising awareness.

Salvaña's advocacy work has been featured in Science, and he has been recognized with numerous national and international awards including the "Ten Outstanding Young Persons of the World" from JCI International and the Young Physician Leader Award from the Interacademy Medical Panel of the World Academy of Sciences. He was named a TED Fellow in 2017.

More profile about the speaker
Edsel Salvaña | Speaker | TED.com
TEDGlobal 2017

Edsel Salvaña: The dangerous evolution of HIV

Edsel Salvaña: Faren ved HIV's transformering

Filmed:
1,305,559 views

Er vi ved at besejre HIV? Muligvis ikke - den næste bølge af behandlingsresistente, modificerede vira er på vej. I et indsigtsfuldt foredrag beskriver TED Fellow, Edsel Salvaña, den aggressive HIV undertype AE, som for tiden hærger hans hjemland, Filippinerne - og advarer mod det, der nemt kan være en lurende global epidemi.
- Infectious disease specialist, molecular epidemiologist
TED Fellow Edsel Salvaña studies the genetics of HIV, and he worries that we are just a few mutations away from the next deadly pandemic. Full bio

Double-click the English transcript below to play the video.

00:12
The PhilippinesFilippinerne: an idyllicidylliske countryLand
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Filippinerne: Et idyllisk land
00:15
with some of the clearestklareste watervand
and bluestbluest skiesskyer on the planetplanet.
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med noget af Jordens klareste
vand og blå himmel.
00:19
It is alsoogså the epicenterepicenter
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Men også centrum
00:20
of one of the fastest-growinghurtigst voksende
HIVHIV epidemicsepidemier in the worldverden.
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for en af de hurtigst
voksende HIV epidemier i verden.
00:24
On the surfaceoverflade, it seemsser ud til
as if we are just a latesent bloomerbloomer.
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Det kan se ud som om, vi blot
er kommet lidt sent i gang.
00:28
HoweverMen, the reasonsgrunde
for our currentnuværende epidemicepidemi
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Men årsagen til vores nuværende epidemi
00:31
are much more complicatedkompliceret
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er langt mere kompliceret,
00:33
and maykan foreshadowforløbere
a globalglobal resurgencegenopblussen of HIVHIV.
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og kan være forstadie til en global
genopblussen af HIV.
00:38
While overallsamlet set newny casessager of HIVHIV
continueBlive ved to dropdråbe in the worldverden,
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Antallet af HIV smittede er
fortsat faldende verden over,
00:42
this trendtrend maykan be short-livedkortvarig
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men den tendens bliver muligvis kortvarig,
00:45
when the nextNæste wavebølge of more aggressiveaggressiv
and resistantresistente virusesvirus arriveankomme.
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med en ny bølge af mere
aggressive og resistente vira.
00:49
HIVHIV has a potentialpotentiel to transformomdanne itselfsig selv
into a newny and differentforskellige virusvirus
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HIV kan potentielt mutere
til en ny og anderledes virus
00:55
everyhver time it infectsinficerer a cellcelle.
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hver gang den inficerer en celle.
00:57
DespiteTrods the remarkablebemærkelsesværdig progressfremskridt
we'vevi har madelavet in reversingvende the epidemicepidemi,
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På trods af de enestående fremskridt
med at bekæmpe epidemien,
01:01
the truthsandhed is that we are just a few
viralviral mutationsmutationer away from disasterkatastrofe.
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er sandheden, at vi kun er et par
virale mutationer fra en katastrofe.
01:07
To appreciatesætter pris på the profounddybtgående way
in whichhvilken HIVHIV transformstransformationer itselfsig selv
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For at forstå den enestående måde,
hvorpå HIV transformerer sig selv
01:11
everyhver time it reproducesgengiver,
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hver gang den reproduceres,
01:12
let's make a geneticgenetiske comparisonsammenligning.
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laver vi en genetisk sammenligning.
01:15
If we look at the DNADNA variationvariation
amongblandt humansmennesker of differentforskellige racesløb
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Når vi ser på DNA variationen blandt menneskeracer
01:18
from differentforskellige continentskontinenter,
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fra forskellige kontinenter,
01:20
the actualfaktiske DNADNA differenceforskel
is only 0.1 percentprocent.
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er den egentlige forskel på DNA kun 0,1%.
01:24
If we look at the geneticgenetiske differenceforskel
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Hvis vi ser på den genetiske forskel
01:26
betweenmellem humansmennesker, great apesaber,
and rhesusRhesus macaquesmakakaber,
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på mennesker, menneskeaber og makakaber,
01:30
that numbernummer is sevensyv percentprocent.
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er tallet 7%.
01:33
In contrastkontrast, the geneticgenetiske differenceforskel
betweenmellem HIVHIV subtypesundertyper
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I kontrast hertil er den genetiske forskel på HIV undertyper
01:37
from differentforskellige patientspatienter
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fra forskellige patienter
01:39
maykan be as much as 35 percentprocent.
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helt op til 35%.
01:42
WithinInden for a personperson infectedinficeret with HIVHIV,
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En person, der er smittet med HIV,
01:44
the geneticgenetiske differenceforskel
betweenmellem an infectinginficere mothermor virusvirus
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kan udvise genetiske forskelle mellem
den inficerende modervirus
01:48
and subsequentefterfølgende daughterdatter virusesvirus
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og efterfølgende datter-vira
01:50
has been shownvist to be
as much as fivefem percentprocent.
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på så meget som 5%.
01:53
This is the equivalenttilsvarende of a gorillagorilla
givinggiver birthfødsel to a chimpanzeechimpanse,
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Det svarer til en gorilla, der føder en chimpanse,
01:58
then to an orangutanorangutang,
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derpå en orangutang,
01:59
then to a baboonbavian,
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så en bavian,
02:01
then to any randomtilfældig great apeAPE
withininden for its lifetimelivstid.
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og herefter alle mulige
andre aber.
Der er næsten 100 undertyper af HIV,
02:04
There are nearlynæsten 100 subtypesundertyper of HIVHIV,
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02:08
with newny subtypesundertyper
beingvære discoveredopdaget regularlyregelmæssigt.
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og der opdages
regelmæssigt nye undertyper.
02:11
HIVHIV in the developedudviklede sig worldverden
is almostnæsten all of one subtypeundertype:
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HIV i udviklingslande er næsten
altid den samme underrtype:
02:16
subtypeundertype B.
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Undertype B.
02:18
MostlyFor det meste everything we know
and do to treatbehandle HIVHIV
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Det meste af vores viden om HIV
02:22
is basedbaseret on studiesundersøgelser on subtypeundertype B,
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er baseret på studier af undertype B,
02:26
even thoughselvom it only
accountskonti for 12 percentprocent
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selv om den kun udgør 12 procent
02:28
of the totalTotal numbernummer
of casessager of HIVHIV in the worldverden.
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af HIV tilfælde i verden.
02:33
But because of the profounddybtgående
geneticgenetiske differenceforskel
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Men p.g.a. de store genetiske forskelle
02:35
amongblandt differentforskellige subtypesundertyper,
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på undertyperne,
02:38
some subtypesundertyper are more likelysandsynligt
to becomeblive drug-resistantresistente
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er det mere sandsynligt at visse
undertyper bliver resistente,
02:42
or progressfremskridt to AIDSAIDS fasterhurtigere.
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eller hurtigere udvikler sig til AIDS.
02:44
We discoveredopdaget that the explosioneksplosion
of HIVHIV casessager in the PhilippinesFilippinerne
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Vi opdagede, at stigningen i
HIV tilfælde på Filippinerne
02:49
is duepå grund to a shiftflytte
from the WesternWestern subtypeundertype B
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skyldes en forskydning væk fra
den vestlige undertype B
02:53
to a more aggressiveaggressiv
SoutheastSydøst AsianAsiatiske subtypeundertype AEAE.
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til den mere aggressive
sydøstasiatiske undertype AE.
02:58
We are seeingat se youngeryngre and sickersygere patientspatienter
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Vi oplever patienter,
der er yngre og mere syge,
03:01
with highhøj ratessatser of drugmedicin resistancemodstand.
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med høj resistens over for behandling.
03:04
InitialIndledende encroachmentindgreb of this subtypeundertype
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Denne undertype er allerede så småt
begyndt at trænge ind
03:07
is alreadyallerede occurringforekommende
in developedudviklede sig countrieslande,
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i udviklede lande,
03:09
includinginklusive AustraliaAustralien,
CanadaCanada and the UnitedUnited StatesStater.
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herunder Australien, Canada og U.S.A.
03:13
We maykan soonsnart see a similarlignende
explosioneksplosion of casessager in these countrieslande.
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Måske oplever vi snart en tilsvarende
eksplosion af HIV tilfælde i disse lande.
03:19
And while we think that HIVHIV is doneFærdig
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Bedst som vi tror, at
HIV er under kontrol,
03:22
and that the tidetidevand has turnedvendt for it,
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og vi har vundet kampen,
03:24
just like with realægte tidestidevand,
it can come right back.
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kan det komme igen
med fornyet styrke
03:27
In the earlytidlig 1960s,
malariamalaria was on the ropesreb.
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I starten af 1960'erne
blev malaria nedkæmpet.
03:31
As the numbernummer of casessager droppeddroppet,
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Og mens antallet af tilfælde faldt,
03:33
people and governmentsregeringer
stoppedholdt op payingbetale attentionopmærksomhed.
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mistede regeringer og
borgere interessen.
03:36
The resultresultat was a deadlydødelig resurgencegenopblussen
of drug-resistantresistente malariamalaria.
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Resultatet var en dødelig genopblussen
af behandlingsresistent malaria.
03:41
We need to think of HIVHIV
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Vi må se på HIV,
03:43
not as a singleenkelt virusvirus
that we think we'vevi har figuredregnede out,
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ikke blot som en enkelt virus,
vi tror, vi har gennemskuet,
03:46
but as a collectionkollektion of rapidlyhurtigt evolvingudviklende
and highlymeget uniqueenestående virusesvirus,
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men som en samling vira, der udvikles
i hver sin unikke retning,
03:53
eachhver of whichhvilken can setsæt off
the nextNæste deadlydødelig epidemicepidemi.
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og kan være startskuddet til
en ny dødelig epidemi.
03:56
We are incorporatinginkorporering
more powerfulkraftfuld and newny toolsværktøjer
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Vi bruger nye og stærkere redskaber
04:00
to help us detectopdage
the nextNæste deadlydødelig HIVHIV strainstamme,
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i forsøget på at opfange den
næste dødelige HIV type,
04:03
and this needsbehov to go handhånd in handhånd
with urgentpresserende researchforskning
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og det skal ske parallelt med
med akut forskning i
04:07
on the behavioropførsel and properkorrekt treatmentbehandling
of non-Bikke-B subtypesundertyper.
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behandlingen af undertyper der
er forskellige fra B
04:12
We need to convinceoverbevise our governmentsregeringer
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Vi må overbevise vore regeringer
04:14
and our fundingfinansiering agenciesagenturer
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og finansierende institutioner om,
04:15
that HIVHIV is not yetendnu doneFærdig.
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at HIV ikke er besejret.
04:20
Over 35 millionmillion people have dieddøde of HIVHIV.
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Over 35 millioner er døde af HIV.
04:25
We are on the vergeranden
of an AIDS-freeAIDS-fri generationgeneration.
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Vi er tæt på en AIDS-fri generation.
04:28
We need to paybetale attentionopmærksomhed.
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Vi skal holde fokus.
04:30
We need to remainforblive vigilantpå vagt
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Vi skal forblive årvågne
04:33
and followfølge efter throughigennem.
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og gør arbejdet færdigt.
04:34
OtherwiseEllers, millionsmillioner more will die.
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Ellers vil flere millioner dø.
04:37
Thank you.
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Tak.
04:38
(ApplauseBifald)
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(Klapsalve)
Translated by Solveig Vendelbo
Reviewed by Niels Justus

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ABOUT THE SPEAKER
Edsel Salvaña - Infectious disease specialist, molecular epidemiologist
TED Fellow Edsel Salvaña studies the genetics of HIV, and he worries that we are just a few mutations away from the next deadly pandemic.

Why you should listen

Dr. Edsel Salvaña discovered that the driving force behind a new AIDS epidemic in the Philippines is the entry and spread of a deadlier strain of HIV -- a situation that can easily occur anywhere in the world.

Salvaña is an infectious disease specialist, molecular epidemiologist and is the director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines in Manila. He is using next-generation sequencing and other cutting-edge genetic tools to study HIV viral diversity and superinfection. He is looking at how HIV develops drug resistance to better understand why his country suddenly has the fastest growing HIV epidemic in Asia; and why HIV treatment that works well in developed countries is failing on emerging HIV strains in the Philippines and resource-limited settings. He trains doctors in infectious diseases, and supervises the care of several thousand HIV patients at the Philippine General Hospital. He has been a national force in the formulation of HIV treatment guidelines, campaigning against stigma, and raising awareness.

Salvaña's advocacy work has been featured in Science, and he has been recognized with numerous national and international awards including the "Ten Outstanding Young Persons of the World" from JCI International and the Young Physician Leader Award from the Interacademy Medical Panel of the World Academy of Sciences. He was named a TED Fellow in 2017.

More profile about the speaker
Edsel Salvaña | Speaker | TED.com