TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvana: A perigosa evolución do VIH
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Pensabas que estábamos a gañar a batalla contra o VIH? Quizáis non xa que unha nova ola de virus adaptados e resistente ás mendiñas está a chegar. Nunha charla que abre ós ollos, Edsel Salvaña describe o agresivo subtipo AE que actualmente é unha plaga no seu fogar nas Filipinas. Alértanos sobre o que pode facilmente chegar a ser unha epidemia global.
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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As Filipinas: un país idílico
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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cunhas das augas máis claras
e cos ceos máis azuis do planeta.
e cos ceos máis azuis do planeta.
00:19
It is also the epicenter
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Tamén é o epicentro
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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dunha das epidemias de maior crecemento
de VIH no mundo.
de VIH no mundo.
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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A simple vista, parece coma se fósemos
un caso tardío.
un caso tardío.
00:28
However, the reasons
for our current epidemic
for our current epidemic
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Non obstante, as razóns da
actual epidemia
actual epidemia
00:31
are much more complicated
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son moito máis complicadas.
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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e poden ensombrecer
o rexurdir global do VIH.
o rexurdir global do VIH.
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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Mentres que en xeral os novos casos de VIH
continúan a diminuir no mundo
continúan a diminuir no mundo
00:42
this trend may be short-lived
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esta tendencia poder ter unha vida curta
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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cando a seguinte oleada dun virus máis
resistente e agresivo apareza.
resistente e agresivo apareza.
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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O VIH ten o potencial de transformarse
nun novo diferente virus
nun novo diferente virus
00:55
every time it infects a cell.
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cada vez que infecta
unha célula.
unha célula.
00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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A pesares do remarcable progreso
que fixemos en revocar a epidemia,
que fixemos en revocar a epidemia,
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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a verdade é que estamos só a poucas
mutacións do completo desastre,
mutacións do completo desastre,
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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Para apreciar a semexante maneira
na que o VIH se transforma
na que o VIH se transforma
01:11
every time it reproduces,
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cada vez que se reproduce,
01:12
let's make a genetic comparison.
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imos facer unha comparación.
01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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Se miramos a variación do ADN
entre humanos de diferences razas
entre humanos de diferences razas
01:18
from different continents,
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de diferentes continentes,
01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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a diferencia real no ADN
é só de un 0.1%.
é só de un 0.1%.
01:24
If we look at the genetic difference
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Se miramos a diferencia xenética
01:26
between humans, great apes,
and rhesus macaques,
and rhesus macaques,
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entre humanos, grandes simios,
e macacos rhesus,
e macacos rhesus,
01:30
that number is seven percent.
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este número é sete por cento.
01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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Polo contrario, a diferencia xenética
entre os subtipos de VIH
entre os subtipos de VIH
01:37
from different patients
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de diferentes pacientes
01:39
may be as much as 35 percent.
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pode ser ata de o 35%.
01:42
Within a person infected with HIV,
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Nunha persoa afectada polo VIH,
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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a diferencia xenética
entre un virus madre infeccioso
entre un virus madre infeccioso
01:48
and subsequent daughter viruses
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e os posteriores virus filla
01:50
has been shown to be
as much as five percent.
as much as five percent.
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está a demostrar que é do 5%.
01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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Isto é o equivaliente a un gorila
dando a luz a un chimpancé,
dando a luz a un chimpancé,
01:58
then to an orangutan,
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logo a un orangután,
01:59
then to a baboon,
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logo a un babuíno,
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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e a grandes simios aleatoriamente
ó largo da súa vida.
ó largo da súa vida.
02:04
There are nearly 100 subtypes of HIV,
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Existen preto de 100 subtipos de VIH,
02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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con novos subtipos
descubríndose regularmente.
descubríndose regularmente.
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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O VIH no mundo desenvolvido
e case sempre da misma clase:
e case sempre da misma clase:
02:16
subtype B.
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subtipo B.
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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A maioría do que sabemos
e como tratamos o VIH
e como tratamos o VIH
02:22
is based on studies on subtype B,
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está basdo en estudos do subtipo B,
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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aínda que so é o 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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do número total de casos
de VIH no mundo.
de VIH no mundo.
02:33
But because of the profound
genetic difference
genetic difference
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Pero debido á profunda
diferencia xenética
diferencia xenética
02:35
among different subtypes,
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entre os diferetes subtipos,
02:38
some subtypes are more likely
to become drug-resistant
to become drug-resistant
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algúns subtipos son máis probables
de resistir ás menciñas
de resistir ás menciñas
02:42
or progress to AIDS faster.
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ou levar ó sida máis axiña.
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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Descubrimos que a explosión
de casos de VIH nas Filipinas
de casos de VIH nas Filipinas
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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é debido a un xiro
do subtipo B occidental
do subtipo B occidental
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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a un subtipo AE sudasiático
máis agresivo.
máis agresivo.
02:58
We are seeing younger and sicker patients
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Vemos pacientes máis xóvenes e enfermos
03:01
with high rates of drug resistance.
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cunha alta resistencia
ás menciñas
ás menciñas
03:04
Initial encroachment of this subtype
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A invasión inicial de este subtipo
03:07
is already occurring
in developed countries,
in developed countries,
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está xa a ocurrir
en paises desenrolados,
en paises desenrolados,
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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incluíndo Australia,
Canadá e os Estados Unidos.
Canadá e os Estados Unidos.
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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Podemos ver pronto unha explosión similar
nestes países.
nestes países.
03:19
And while we think that HIV is done
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E mentres cremos que o VIH
desapareceu
desapareceu
03:22
and that the tide has turned for it,
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e que a marea pasou
03:24
just like with real tides,
it can come right back.
it can come right back.
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como nas mareas reais
pode voltar.
pode voltar.
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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Nos 60
a malaria estaba contra ás cordas.
a malaria estaba contra ás cordas.
03:31
As the number of cases dropped,
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Así como os casos diminuíron,
03:33
people and governments
stopped paying attention.
stopped paying attention.
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a xente e os gobernos
deixaron de prestar atención.
deixaron de prestar atención.
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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O resultado foi un rexurdir mortal
dunha malaria resistente ás menciñas.
dunha malaria resistente ás menciñas.
03:41
We need to think of HIV
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Precisamos pensar no VIH
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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non coma un virus
que creemos coñecer
que creemos coñecer
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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pero como unha colección de virus
moi únicos de desenvolvemento rápido,
moi únicos de desenvolvemento rápido,
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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cada un pode levar á seguirnte
epidemia mortal.
epidemia mortal.
03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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Estamos a incorporar ferramentas
novas e máis poderosas
novas e máis poderosas
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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que nos azuden a detectar
o seguinte tipo mortal de VIH,
o seguinte tipo mortal de VIH,
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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e isto precisa ir man a man
cunha investigación urxente
cunha investigación urxente
04:07
on the behavior and proper treatment
of non-B subtypes.
of non-B subtypes.
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no comportamento e tratamento
adecuao dos tipos non B.
adecuao dos tipos non B.
04:12
We need to convince our governments
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Necesitamos convencer
ós nosos gobernos
ós nosos gobernos
e ós organismos
financieiros
financieiros
04:14
and our funding agencies
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04:15
that HIV is not yet done.
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que o VIH non é unha cousa do pasado.
04:20
Over 35 million people have died of HIV.
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Ó redor de 35 millóns de persoas morreron
a causa do VIH.
a causa do VIH.
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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Estamos no fronteira dunha xeración
libre de sida
libre de sida
04:28
We need to pay attention.
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Precisamos prestar atención.
04:30
We need to remain vigilant
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Precisamos estar á vixía
04:33
and follow through.
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e facer un seguimento.
04:34
Otherwise, millions more will die.
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Senón, millóns máis morrerán.
04:37
Thank you.
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Grazas.
04:38
(Applause)
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(Aplauso)
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