English-Video.net comment policy

The comment field is common to all languages

Let's write in your language and use "Google Translate" together

Please refer to informative community guidelines on TED.com

TEDGlobal 2017

Edsel Salvaña: The dangerous evolution of HIV

Filmed:
1,200,912 views

Think we're winning the battle against HIV? Maybe not, as the next wave of drug-resistant viruses arrives. In an eye-opening talk, TED Fellow Edsel Salvana describes the aggressive HIV subtype AE that's currently plaguing his home of the Philippines -- and warns us about what might become a global epidemic.

- 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

The Philippines: an idyllic country
00:12
with some of the clearest water
and bluest skies on the planet.
00:15
It is also the epicenter
00:19
of one of the fastest-growing
HIV epidemics in the world.
00:20
On the surface, it seems
as if we are just a late bloomer.
00:24
However, the reasons
for our current epidemic
00:28
are much more complicated
00:31
and may foreshadow
a global resurgence of HIV.
00:33
While overall new cases of HIV
continue to drop in the world,
00:38
this trend may be short-lived
00:42
when the next wave of more aggressive
and resistant viruses arrive.
00:45
HIV has a potential to transform itself
into a new and different virus
00:49
every time it infects a cell.
00:55
Despite the remarkable progress
we've made in reversing the epidemic,
00:57
the truth is that we are just a few
viral mutations away from disaster.
01:01
To appreciate the profound way
in which HIV transforms itself
01:07
every time it reproduces,
01:11
let's make a genetic comparison.
01:12
If we look at the DNA variation
among humans of different races
01:15
from different continents,
01:18
the actual DNA difference
is only 0.1 percent.
01:20
If we look at the genetic difference
01:24
between humans, great apes,
and rhesus macaques,
01:26
that number is seven percent.
01:30
In contrast, the genetic difference
between HIV subtypes
01:33
from different patients
01:37
may be as much as 35 percent.
01:39
Within a person infected with HIV,
01:42
the genetic difference
between an infecting mother virus
01:44
and subsequent daughter viruses
01:48
has been shown to be
as much as five percent.
01:50
This is the equivalent of a gorilla
giving birth to a chimpanzee,
01:53
then to an orangutan,
01:58
then to a baboon,
01:59
then to any random great ape
within its lifetime.
02:01
There are nearly 100 subtypes of HIV,
02:04
with new subtypes
being discovered regularly.
02:08
HIV in the developed world
is almost all of one subtype:
02:11
subtype B.
02:16
Mostly everything we know
and do to treat HIV
02:18
is based on studies on subtype B,
02:22
even though it only
accounts for 12 percent
02:26
of the total number
of cases of HIV in the world.
02:28
But because of the profound
genetic difference
02:33
among different subtypes,
02:35
some subtypes are more likely
to become drug-resistant
02:38
or progress to AIDS faster.
02:42
We discovered that the explosion
of HIV cases in the Philippines
02:44
is due to a shift
from the Western subtype B
02:49
to a more aggressive
Southeast Asian subtype AE.
02:53
We are seeing younger and sicker patients
02:58
with high rates of drug resistance.
03:01
Initial encroachment of this subtype
03:04
is already occurring
in developed countries,
03:07
including Australia,
Canada and the United States.
03:09
We may soon see a similar
explosion of cases in these countries.
03:13
And while we think that HIV is done
03:19
and that the tide has turned for it,
03:22
just like with real tides,
it can come right back.
03:24
In the early 1960s,
malaria was on the ropes.
03:27
As the number of cases dropped,
03:31
people and governments
stopped paying attention.
03:33
The result was a deadly resurgence
of drug-resistant malaria.
03:36
We need to think of HIV
03:41
not as a single virus
that we think we've figured out,
03:43
but as a collection of rapidly evolving
and highly unique viruses,
03:46
each of which can set off
the next deadly epidemic.
03:53
We are incorporating
more powerful and new tools
03:56
to help us detect
the next deadly HIV strain,
04:00
and this needs to go hand in hand
with urgent research
04:03
on the behavior and proper treatment
of non-B subtypes.
04:07
We need to convince our governments
04:12
and our funding agencies
04:14
that HIV is not yet done.
04:15
Over 35 million people have died of HIV.
04:20
We are on the verge
of an AIDS-free generation.
04:25
We need to pay attention.
04:28
We need to remain vigilant
04:30
and follow through.
04:33
Otherwise, millions more will die.
04:34
Thank you.
04:37
(Applause)
04:38

▲Back to top

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