TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvaña: Faren ved HIV's transformering
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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.
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. Full bio
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 Philippines: an idyllic country
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Filippinerne: Et idyllisk land
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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med noget af Jordens klareste
vand og blå himmel.
vand og blå himmel.
00:19
It is also the epicenter
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Men også centrum
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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for en af de hurtigst
voksende HIV epidemier i verden.
voksende HIV epidemier i verden.
00:24
On the surface, it seems
as if we are just a late bloomer.
as if we are just a late bloomer.
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Det kan se ud som om, vi blot
er kommet lidt sent i gang.
er kommet lidt sent i gang.
00:28
However, the reasons
for our current epidemic
for our current epidemic
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Men årsagen til vores nuværende epidemi
00:31
are much more complicated
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er langt mere kompliceret,
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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og kan være forstadie til en global
genopblussen af HIV.
genopblussen af HIV.
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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Antallet af HIV smittede er
fortsat faldende verden over,
fortsat faldende verden over,
00:42
this trend may be short-lived
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men den tendens bliver muligvis kortvarig,
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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med en ny bølge af mere
aggressive og resistente vira.
aggressive og resistente vira.
00:49
HIV has a potential to transform itself
into a new and different virus
into a new and different virus
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HIV kan potentielt mutere
til en ny og anderledes virus
til en ny og anderledes virus
00:55
every time it infects a cell.
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hver gang den inficerer en celle.
00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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På trods af de enestående fremskridt
med at bekæmpe epidemien,
med at bekæmpe epidemien,
01:01
the truth is that we are just a few
viral mutations away from disaster.
viral mutations away from disaster.
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er sandheden, at vi kun er et par
virale mutationer fra en katastrofe.
virale mutationer fra en katastrofe.
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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For at forstå den enestående måde,
hvorpå HIV transformerer sig selv
hvorpå HIV transformerer sig selv
01:11
every time it reproduces,
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hver gang den reproduceres,
01:12
let's make a genetic comparison.
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laver vi en genetisk sammenligning.
01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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Når vi ser på DNA variationen blandt menneskeracer
01:18
from different continents,
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fra forskellige kontinenter,
01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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er den egentlige forskel på DNA kun 0,1%.
01:24
If we look at the genetic difference
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Hvis vi ser på den genetiske forskel
01:26
between humans, great apes,
and rhesus macaques,
and rhesus macaques,
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på mennesker, menneskeaber og makakaber,
01:30
that number is seven percent.
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er tallet 7%.
01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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I kontrast hertil er den genetiske forskel på HIV undertyper
01:37
from different patients
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fra forskellige patienter
01:39
may be as much as 35 percent.
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helt op til 35%.
01:42
Within a person infected with HIV,
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En person, der er smittet med HIV,
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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kan udvise genetiske forskelle mellem
den inficerende modervirus
den inficerende modervirus
01:48
and subsequent daughter viruses
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og efterfølgende datter-vira
01:50
has been shown to be
as much as five percent.
as much as five percent.
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på så meget som 5%.
01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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Det svarer til en gorilla, der føder en chimpanse,
01:58
then to an orangutan,
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derpå en orangutang,
01:59
then to a baboon,
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så en bavian,
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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og herefter alle mulige
andre aber.
andre aber.
Der er næsten 100 undertyper af HIV,
02:04
There are nearly 100 subtypes of HIV,
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02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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og der opdages
regelmæssigt nye undertyper.
regelmæssigt nye undertyper.
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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HIV i udviklingslande er næsten
altid den samme underrtype:
altid den samme underrtype:
02:16
subtype B.
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Undertype B.
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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Det meste af vores viden om HIV
02:22
is based on studies on subtype B,
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er baseret på studier af undertype B,
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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selv om den kun udgør 12 procent
02:28
of the total number
of cases of HIV in the world.
of cases of HIV in the world.
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af HIV tilfælde i verden.
02:33
But because of the profound
genetic difference
genetic difference
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Men p.g.a. de store genetiske forskelle
02:35
among different subtypes,
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på undertyperne,
02:38
some subtypes are more likely
to become drug-resistant
to become drug-resistant
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er det mere sandsynligt at visse
undertyper bliver resistente,
undertyper bliver resistente,
02:42
or progress to AIDS faster.
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eller hurtigere udvikler sig til AIDS.
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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Vi opdagede, at stigningen i
HIV tilfælde på Filippinerne
HIV tilfælde på Filippinerne
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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skyldes en forskydning væk fra
den vestlige undertype B
den vestlige undertype B
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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til den mere aggressive
sydøstasiatiske undertype AE.
sydøstasiatiske undertype AE.
02:58
We are seeing younger and sicker patients
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Vi oplever patienter,
der er yngre og mere syge,
der er yngre og mere syge,
03:01
with high rates of drug resistance.
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med høj resistens over for behandling.
03:04
Initial encroachment of this subtype
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Denne undertype er allerede så småt
begyndt at trænge ind
begyndt at trænge ind
03:07
is already occurring
in developed countries,
in developed countries,
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i udviklede lande,
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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herunder Australien, Canada og U.S.A.
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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Måske oplever vi snart en tilsvarende
eksplosion af HIV tilfælde i disse lande.
eksplosion af HIV tilfælde i disse lande.
03:19
And while we think that HIV is done
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Bedst som vi tror, at
HIV er under kontrol,
HIV er under kontrol,
03:22
and that the tide has turned for it,
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og vi har vundet kampen,
03:24
just like with real tides,
it can come right back.
it can come right back.
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kan det komme igen
med fornyet styrke
med fornyet styrke
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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I starten af 1960'erne
blev malaria nedkæmpet.
blev malaria nedkæmpet.
03:31
As the number of cases dropped,
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Og mens antallet af tilfælde faldt,
03:33
people and governments
stopped paying attention.
stopped paying attention.
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mistede regeringer og
borgere interessen.
borgere interessen.
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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Resultatet var en dødelig genopblussen
af behandlingsresistent malaria.
af behandlingsresistent malaria.
03:41
We need to think of HIV
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Vi må se på HIV,
03:43
not as a single virus
that we think we've figured out,
that we think we've figured out,
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ikke blot som en enkelt virus,
vi tror, vi har gennemskuet,
vi tror, vi har gennemskuet,
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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men som en samling vira, der udvikles
i hver sin unikke retning,
i hver sin unikke retning,
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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og kan være startskuddet til
en ny dødelig epidemi.
en ny dødelig epidemi.
03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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Vi bruger nye og stærkere redskaber
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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i forsøget på at opfange den
næste dødelige HIV type,
næste dødelige HIV type,
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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og det skal ske parallelt med
med akut forskning i
med akut forskning i
04:07
on the behavior and proper treatment
of non-B subtypes.
of non-B subtypes.
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behandlingen af undertyper der
er forskellige fra B
er forskellige fra B
04:12
We need to convince our governments
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Vi må overbevise vore regeringer
04:14
and our funding agencies
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og finansierende institutioner om,
04:15
that HIV is not yet done.
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at HIV ikke er besejret.
04:20
Over 35 million people have died of HIV.
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Over 35 millioner er døde af HIV.
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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Vi er tæt på en AIDS-fri generation.
04:28
We need to pay attention.
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Vi skal holde fokus.
04:30
We need to remain vigilant
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Vi skal forblive årvågne
04:33
and follow through.
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og gør arbejdet færdigt.
04:34
Otherwise, millions more will die.
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Ellers vil flere millioner dø.
04:37
Thank you.
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Tak.
04:38
(Applause)
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(Klapsalve)
ABOUT THE SPEAKER
Edsel Salvaña - Infectious disease specialist, molecular epidemiologistTED 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.
Edsel Salvaña | Speaker | TED.com