TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
艾德索沙爾瓦納: 愛滋病病毒的危險演化
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我們打贏了對抗愛滋病之戰嗎？也許沒有──下一波有抗藥性及適應性的病毒就要來了。在這場讓人開眼界的演說中，TED 成員艾德索沙爾瓦納描述了侵略性的 AE 亞種愛滋病病毒，這種病毒目前正讓他的家鄉菲律賓陷入災苦中。他也警告我們，這很可能演變成一場全球流行。
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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菲律賓這個國家有著田園風光，
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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以及地球上一部分
最清澈的水和最藍的天。
最清澈的水和最藍的天。
00:19
It is also the epicenter
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它也是世界上愛滋病病毒傳播最快的
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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區域中心之一。
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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表面上看起來，
似乎我們只是遲開的花朵。
似乎我們只是遲開的花朵。
00:28
However, the reasons
for our current epidemic
for our current epidemic
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然而，目前我們的病毒如此流行，
00:31
are much more complicated
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背後的原因複雜很多，
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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且有可能是愛滋病病毒
於全球捲土重來的前兆。
於全球捲土重來的前兆。
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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雖然全世界愛滋病
新病例的數量在持續下降，
新病例的數量在持續下降，
00:42
this trend may be short-lived
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但這個趨勢可能很短暫，
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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下一波更有侵略性、
更頑強的病毒很快就會到來。
更頑強的病毒很快就會到來。
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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每當愛滋病病毒感染一個細胞時，
它就有潛力將它自己轉變為
它就有潛力將它自己轉變為
00:55
every time it infects a cell.
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不同的新病毒。
00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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儘管我們在控制病毒
傳播方面有不錯的進展，
傳播方面有不錯的進展，
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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真相是，再來幾次病毒突變，
就可能會帶來一場災難。
就可能會帶來一場災難。
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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為了進一步了解愛滋病病毒
每次複製繁殖時
每次複製繁殖時
01:11
every time it reproduces,
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轉化為其他病毒的複雜肌理，
01:12
let's make a genetic comparison.
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讓我們來做一項基因比較。
01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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比較不同大陸、不同人種間的 DNA 差異，
01:18
from different continents,
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實際的 DNA 差異只有 0.1%。
01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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如果比較的基因差異
01:24
If we look at the genetic difference
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是在人類、類人猿以及獼猴之間的，
01:26
between humans, great apes,
and rhesus macaques,
and rhesus macaques,
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01:30
that number is seven percent.
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這個數字為 7%。
01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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相對之下，不同病人的
愛滋病病毒亞型之間，
愛滋病病毒亞型之間，
01:37
from different patients
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01:39
may be as much as 35 percent.
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基因差異可能高達 35%。
01:42
Within a person infected with HIV,
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在一個感染了愛滋病病毒的人身上，
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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研究已發現，在感染他的母病毒
01:48
and subsequent daughter viruses
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和後續產生的子病毒之間，
01:50
has been shown to be
as much as five percent.
as much as five percent.
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基因差異可高達 5%。
01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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這就等同於一隻大猩猩
生出一隻黑猩猩，
生出一隻黑猩猩，
01:58
then to an orangutan,
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然後再生出一隻猩猩，
01:59
then to a baboon,
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然後再生出一隻狒狒，
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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然後在其一生中
再生出任何一種類人猿。
再生出任何一種類人猿。
一共有近一百種愛滋病病毒亞型，
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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經常還會發現新的亞型。
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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在發達國家中的愛滋病病毒
幾乎都是同一種亞型的：
幾乎都是同一種亞型的：
02:16
subtype B.
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B 亞型。
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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在治療愛滋病上，
我們大部分的知識和做法，
我們大部分的知識和做法，
02:22
is based on studies on subtype B,
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都以 B 亞型的研究為基礎，
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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但其實這種亞型只佔了
全世界愛滋病案例總數的 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，因為不同亞型間的
基因差異非常深奧，
基因差異非常深奧，
02:35
among different subtypes,
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02:38
some subtypes are more likely
to become drug-resistant
to become drug-resistant
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有些亞型比較可能會發展出抗藥性，
02:42
or progress to AIDS faster.
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或是更快發展成愛滋病。
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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我們發現，在菲律賓的
愛滋病案例大爆發，
愛滋病案例大爆發，
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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背後原因是因為西方的 B 亞型
轉變為更有侵略性的
東南亞 AE 亞型。
東南亞 AE 亞型。
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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我們發現更年輕、病得更重的病人，
03:01
with high rates of drug resistance.
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且病毒的抗藥性很高。
03:04
Initial encroachment of this subtype
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這種亞型的初始侵入
03:07
is already occurring
in developed countries,
in developed countries,
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已經在已發達國家中發生了，
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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包括澳洲、加拿大，以及美國。
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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我們可能很快就會在
這些國家看到病情的集中爆發。
這些國家看到病情的集中爆發。
03:19
And while we think that HIV is done
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雖然我們認為愛滋病已經結束了，
03:22
and that the tide has turned for it,
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局勢已經扭轉，
03:24
just like with real tides,
it can come right back.
it can come right back.
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就像真正的浪潮一樣，
它有可能會捲土重來。
它有可能會捲土重來。
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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在六○年代初，
瘧疾差不多要被消滅了。
瘧疾差不多要被消滅了。
03:31
As the number of cases dropped,
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案例數目減少，
03:33
people and governments
stopped paying attention.
stopped paying attention.
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人們和政府都不再留意。
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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結果卻是具有抗藥性的
瘧疾，致命性地再現。
瘧疾，致命性地再現。
03:41
We need to think of HIV
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我們不能把愛滋病病毒
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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當成一種我們已經研究透徹的東西，
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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而是要把它當作是一群快速演化
且非常獨特的病毒，
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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當中每一個病毒都可能
引發下次致命流行。
引發下次致命流行。
03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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我們正在納入更多新的強大工具，
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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來協助我們偵測出下一個
致命的愛滋病病毒品種，
致命的愛滋病病毒品種，
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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這需要配合
關於非 B 亞型病毒之
行為和適當治療的急迫研究。
行為和適當治療的急迫研究。
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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我們得要說服我們的政府
04:14
and our funding agencies
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以及我們的資助機構，
04:15
that HIV is not yet done.
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告訴他們，對抗愛滋病的鬥爭
還遠沒有結束。
還遠沒有結束。
04:20
Over 35 million people have died of HIV.
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已經有 3500 萬人死於愛滋病。
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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我們正在一個無愛滋病世代的邊緣。
04:28
We need to pay attention.
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我們得要多留心。
04:30
We need to remain vigilant
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我們得要保持警惕，
04:33
and follow through.
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並堅持到底。
04:34
Otherwise, millions more will die.
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不然，還會有更多的人死於愛滋。
04:37
Thank you.
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謝謝。
04:38
(Applause)
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（掌聲）
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