TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvana: 艾滋病毒的危险演变
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你是否也认为我们已经成功遏制住了艾滋病病毒？也许并不如你所想——下一波耐药性病毒即将到来。在这个令人大开眼界的演讲中，TED伙伴Edsel Salvana描述了一种具有及强侵略性的病毒，目前正在他的祖国菲律宾蔓延的艾滋病亚种AE型病毒。他还警告我们，这种病毒将有可能成为迫在眉睫的全球性流行病。
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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菲律宾：一个田园般的国家，
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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这里拥有着这个星球上最清澈的水，最蓝的天。
但是它也是这个世界上，
00:19
It is also the epicenter
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艾滋病蔓延最快的地区之一。
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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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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表面上看，我们似乎只是在这个方面还不成熟。
00:28
However, the reasons
for our current epidemic
for our current epidemic
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但其实，造成我们目前流行病的原因
远比我们所想的要复杂得多，
00:31
are much more complicated
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还有可能预示着艾滋病毒的全球性复苏。
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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虽然世界上新感染的艾滋病毒病例在持续下降，
00:42
this trend may be short-lived
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但当下一波更具有侵略性和抵抗力的病毒到来时，
这种趋势有可能是短暂的。
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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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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艾滋病毒有可能在每次感染细胞时，
转变成一种不同的新型病毒。
00:55
every time it infects a cell.
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00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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尽管我们在扭转这一流行病方面取得了显著的进展，
但事实上，我们离灾难只有几个病毒变异。
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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01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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想要理解艾滋病毒在每次繁殖过程中，
01:11
every time it reproduces,
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是如何改变自身的，
我们可以来做一个基因比较。
01:12
let's make a genetic comparison.
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01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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如果我们观察来自不同大陆，
不同人种之间的DNA变异，
01:18
from different continents,
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实际DNA差异仅为百分之0.1。
01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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01:24
If we look at the genetic difference
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如果我们观察人类，
类人猿和猕猴之间的基因差异，
01:26
between humans, great apes,
and rhesus macaques,
and rhesus macaques,
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差异值为百分之7。
01:30
that number is seven percent.
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01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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相比之下，不同患者的艾滋病毒亚型之间，
01:37
from different patients
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基因差异值，
可能高达百分之35。
01:39
may be as much as 35 percent.
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01:42
Within a person infected with HIV,
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在感染艾滋病毒的人中，
感染母病毒的人，
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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与随后感染子病毒的人，
01:48
and subsequent daughter viruses
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基因差异值高达百分之5。
01:50
has been shown to be
as much as five percent.
as much as five percent.
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01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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这就好比一只大猩猩生下了一只黑猩猩，
然后生下一只猩猩，
01:58
then to an orangutan,
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然后又生下一只狒狒，
01:59
then to a baboon,
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生下任何可能的猿类动物。
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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02:04
There are nearly 100 subtypes of HIV,
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艾滋病毒有将近100种亚型，
02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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新的亚型被定期发现。
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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在发达国家，艾滋病毒大多都是一种亚型：
亚型B.
02:16
subtype B.
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02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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我们所知与所做的治疗，
都是基于对B型病毒的研究，
02:22
is based on studies on subtype B,
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尽管这种B型病毒在世界范围内，
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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只占艾滋病毒病例总数的百分之12。
02:28
of the total number
of cases of HIV in the world.
of cases of HIV in the world.
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02:33
But because of the profound
genetic difference
genetic difference
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但是由于在不同亚型之间，
存在着明显的基因差异，
02:35
among different subtypes,
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一些亚型会更具有抗药性，
02:38
some subtypes are more likely
to become drug-resistant
to become drug-resistant
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02:42
or progress to AIDS faster.
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也有可能更快地发展为艾滋病。
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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我们发现，菲律宾艾滋病的病例激增的原因，
是因为病毒从西方的B型，
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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转变为了更具攻击性的东南亚AE型病毒。
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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02:58
We are seeing younger and sicker patients
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我们发现那些更年轻，病得更严重的病人，
他们的耐药率很高。
03:01
with high rates of drug resistance.
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03:04
Initial encroachment of this subtype
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在一些发达国家中，
一些亚型的初始侵害已经在发生，
03:07
is already occurring
in developed countries,
in developed countries,
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包括澳大利亚，加拿大，美国。
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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我们有可能很快就会在这些国家中看到相同病例的增激。
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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03:19
And while we think that HIV is done
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当我们认为艾滋病毒已经被遏制，
03:22
and that the tide has turned for it,
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而且趋势也有所扭转，
就像真的控制住了一样，但它依然有可能再复发。
03:24
just like with real tides,
it can come right back.
it can come right back.
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03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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在上世纪六十年代初，疟疾即将绝迹。
随着病例数量的减少，
03:31
As the number of cases dropped,
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人们及政府也对此放松警惕。
03:33
people and governments
stopped paying attention.
stopped paying attention.
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造成的结果是抗药性疟疾死灰复燃。
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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03:41
We need to think of HIV
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我们不应该把艾滋病毒视为
我们所认为已经发现的单一病毒，
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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而是应该把它视为一个快速进化，
极其独特的病毒集合体，
极其独特的病毒集合体，
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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每一种病毒都会引发下一个致命的流行病。
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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我们正在研发更有效的新器械，
来帮助我们检测下一个致命的艾滋病毒株，
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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这需要我们对非B型病毒的特征 ，
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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以及适当的治疗方案同时加紧速度进行研究。
04:07
on the behavior and proper treatment
of non-B subtypes.
of non-B subtypes.
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04:12
We need to convince our governments
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我们要让我们的政府，
以及资助机构意识到，
04:14
and our funding agencies
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艾滋病毒还没有完全遏制。
04:15
that HIV is not yet done.
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04:20
Over 35 million people have died of HIV.
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有超过3500万的人死于艾滋病，
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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我们即将迎来无艾滋的时代，
我们需要关注艾滋病，
04:28
We need to pay attention.
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并保持警惕，
04:30
We need to remain vigilant
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然后一直坚持到底。
04:33
and follow through.
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04:34
Otherwise, millions more will die.
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否则，仍会有数以百万计的人因艾滋病死去。
谢谢！
04:37
Thank you.
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04:38
(Applause)
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（掌声）
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