TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvaña: HIESAren eboluzio arriskitsua.
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HIESAren aurkako borroka irabazten ari garela pentsatzen duzu? Baliteke hala ez izatea. Izan ere, sendagaiei erresistentzia garatu duen birus olatu berri bat iristen ari da. Elkarrizketa errebelatzaile honetan, Edsel Salvana TED lagunak bere herrialdea, Filipinak, erasotzen ari den HIESAren AE mota deskribatzen du. Era berean, ohartarazten digu mundu mailako epidemia posible baten aurrean egon gaitezkeela.
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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Filipinak: herrialde amesgarria
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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mundu osoko ur eta zeru
gardenetarikoekin.
gardenetarikoekin.
00:19
It is also the epicenter
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Baita HIESaren epidemiaren
epizentro garrantzitsuenetarikoa
epizentro garrantzitsuenetarikoa
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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Itxuraz, agerraldi berantiarra
baino ez dela dirudi.
baino ez dela dirudi.
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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Baina epidemia honen arrazoiak
00:28
However, the reasons
for our current epidemic
for our current epidemic
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00:31
are much more complicated
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askoz konplexuagoak dira
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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eta mundu mailako agerraldi
berri baten zeinu izan daitezke.
berri baten zeinu izan daitezke.
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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Mundu osoan kasu berrien kopurua
gutxitzen ari den bitartean,
gutxitzen ari den bitartean,
00:42
this trend may be short-lived
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joera hau laburra izan daiteke
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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agresibo eta erresistentzia handiagoko
birusen olatu berri bat iristerakoan.
birusen olatu berri bat iristerakoan.
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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HIESak, zelula bat infektatzen duen bakoitzean,
bere burua beste motako birus batean
transformatzeko gaitasuna du.
transformatzeko gaitasuna du.
00:55
every time it infects a cell.
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Birus honi aurre egitego
garapen esanguratsuak lortu baditugu ere,
garapen esanguratsuak lortu baditugu ere,
00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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egia esan hondamenetik
mutazio gutxi batzuetara gaude.
mutazio gutxi batzuetara gaude.
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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HIESAren aldakortasuna ikusi
ahal izateko,
ahal izateko,
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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birusa erreproduzitzen den bakoitzean,
01:11
every time it reproduces,
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goazen alderatze genetiko bat egitera:
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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Giza arrazen arteko DNA ezberdintasunei
begiratzen badiegu,
begiratzen badiegu,
01:18
from different continents,
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kontinenteetan zehar,
DNA ezberdintasuna %0,1 baino ez da.
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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Gizakien eta tximinoen artean %7koa da.
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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01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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Alderantziz, ezberdinatsun genetikoa
HIESaren moten artean
HIESaren moten artean
gaixo ezberdinen artean
%35koa izatera heldu daiteke.
%35koa izatera heldu daiteke.
01:37
from different patients
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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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HIESArekin kutsatuta dagoen
pertsona batean
pertsona batean
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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ama birusa eta bere seme birusen
arteko ezberdintasun genetikoa
arteko ezberdintasun genetikoa
01:48
and subsequent daughter viruses
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%5rainokoa dela frogatu da.
01:50
has been shown to be
as much as five percent.
as much as five percent.
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Gorila batek seme tximpanze bat
izatearen balio bera du.
izatearen balio bera du.
01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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Eta segidan orangutan bat izatea,
01:58
then to an orangutan,
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gero babuino bat,
01:59
then to a baboon,
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eta gero edozelako tximino
espezie bat izatea.
espezie bat izatea.
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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Gutxigorabehera 100 HIES mota daude
02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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eta maiz mota berriak aurkitzen dira.
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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HIESa mundo garatuan ia mota batekoa
baino ez da: B mota.
baino ez da: B mota.
02:16
subtype B.
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HIESari aurre egiteko dakigun ia guztia
B motaren ikerketei dagokie.
B motaren ikerketei dagokie.
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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02:22
is based on studies on subtype B,
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Baina mundu osoko kasuen %12 baino ez da.
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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02:28
of the total number
of cases of HIV in the world.
of cases of HIV in the world.
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Ezberdintasun genetikoaren ondorioz,
HIESaren moten arteko batzuk
HIESaren moten arteko batzuk
02:33
But because of the profound
genetic difference
genetic difference
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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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drogei aurre egiteko gaitasun
handiagoa dute
handiagoa dute
02:42
or progress to AIDS faster.
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edota azkarrago garatzen dira.
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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Filipinetako HIES kasuen eztanda,
mendebaldeko B motatik
mendebaldeko B motatik
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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Asia hego-ekialdeko AE mota
agresibo baterako
agresibo baterako
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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aldaketari dagokiola aurkitu dugu.
02:58
We are seeing younger and sicker patients
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Gaixo gazteagoak eta kaltetuagoak
ikusten ari gara
ikusten ari gara
03:01
with high rates of drug resistance.
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sendagaiei erristentzia handiagoarekin.
03:04
Initial encroachment of this subtype
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Mota honen lehen aztarnak
03:07
is already occurring
in developed countries,
in developed countries,
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jadanik ikusten ari dira
herrialde garatuetan,
herrialde garatuetan,
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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hots Australia, Kanada eta Estatu Batuak.
Denbora gutxira kasu eztanda berdin
bat ikusteko probabilitate handia dago.
bat ikusteko probabilitate handia dago.
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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HIESarekin bukatu dugula
pentsatzen dugun bitartean,
pentsatzen dugun bitartean,
03:19
And while we think that HIV is done
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eta gaixotasun honen bolada joan
egin dela pentsatzen dugun bitartean,
egin dela pentsatzen dugun bitartean,
03:22
and that the tide has turned for it,
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03:24
just like with real tides,
it can come right back.
it can come right back.
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berriro agertzea izan liteke.
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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1960ko hamarkadan,
malaria ia garaitua zegoen.
malaria ia garaitua zegoen.
Kasuen kopurua behera
zihoan bitartean,
zihoan bitartean,
03:31
As the number of cases dropped,
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03:33
people and governments
stopped paying attention.
stopped paying attention.
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jendeak eta gobernuek
jaramon egiteari utzi zioten.
jaramon egiteari utzi zioten.
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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Ondorioz sendagai-erresistentzia zuen
malaria baten berragerraldi bat izan zen.
malaria baten berragerraldi bat izan zen.
HIESean pentsatzean
03:41
We need to think of HIV
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ez dugu garaitu dugun birus
bakar batean pentsatu behar,
bakar batean pentsatu behar,
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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baizik eta azkar garatzen ari den
birus talde anitz batean,
birus talde anitz batean,
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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non birus bakoitzak hurrengo epidemia
hilkorra sortu dezakeen.
hilkorra sortu dezakeen.
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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Erreminta berri eta indartsuagoak
sortzen ari gara
sortzen ari gara
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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hurrengo HIESaren mota hilkorra
detektatu ahal izateko
detektatu ahal izateko
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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eta honek premiazko ikerketa baten
ondoan jorratzeko beharra du.
ondoan jorratzeko beharra du.
B mota ez diren moten bilakaera
eta sendatzeko modua ikertzeko.
eta sendatzeko modua ikertzeko.
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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Gobernuei eta agentziei
04:14
and our funding agencies
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buruan sartu behar diegu
04:15
that HIV is not yet done.
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HIESarekin ez dugula bukatu.
04:20
Over 35 million people have died of HIV.
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HIESak 35 milioi pertsona
baino gehiago hil ditu
baino gehiago hil ditu
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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HIESarik gabeko generazio bat lortzeko
aukera dugu.
aukera dugu.
Kontuz ibili behar gara.
04:28
We need to pay attention.
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04:30
We need to remain vigilant
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Erne ibili eta horrela jarraitu
behar dugu
behar dugu
04:33
and follow through.
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Bestela, milioika pertsona gehiago
hilko dira.
hilko dira.
04:34
Otherwise, millions more will die.
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Eskerrik asko.
04:37
Thank you.
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04:38
(Applause)
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(Txaloak)
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