TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvaña: Nevarna evolucija virusa HIV
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Mislite, da zmagujemo v boju proti virusu HIV? Morda ne - saj prihaja nov val prilagojenih virusov odpornih na zdravila. V tem presenetljivem govoru nam TED fellow Edsel Salvana opiše agresivni podtip virusa HIV, AE, ki trenutno pustoši po Filipinih, ki so njegov dom - in nas opozori na nekaj, kar bi zlahka postalo grozeča globalna epidemija.
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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Filipini: idilična država,
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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kjer lahko najdemo najbolj čisto vodo
in najbolj modro nebo na planetu.
in najbolj modro nebo na planetu.
00:19
It is also the epicenter
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Je pa tudi epicenter
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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ene izmed najhitreje rastočih
HIV epidemij na svetu.
HIV epidemij na svetu.
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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Na površju se zdi,
da smo samo pozno začeli.
da smo samo pozno začeli.
00:28
However, the reasons
for our current epidemic
for our current epidemic
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A razlogi za trenutno epidemijo
00:31
are much more complicated
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so veliko bolj zapleteni,
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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in morda naznanjajo
ponovno globalno pojavljanje HIV-a.
ponovno globalno pojavljanje HIV-a.
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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Medtem ko se pojavljanje novih primerov
HIV-a po svetu zmanjšuje,
HIV-a po svetu zmanjšuje,
00:42
this trend may be short-lived
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gre morda za kratkoročen trend
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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pred prihodom naslednjega vala
agresivnih in odpornih virusov.
agresivnih in odpornih virusov.
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 se lahko spremeni
v nov in drugačen virus,
v nov in drugačen virus,
00:55
every time it infects a cell.
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vsakič ko okuži neko celico.
00:57
Despite the remarkable progress
we've made in reversing the epidemic,
we've made in reversing the epidemic,
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Ne glede na neverjeten napredek,
ki smo ga dosegli pri zaviranju epidemije,
ki smo ga dosegli pri zaviranju epidemije,
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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smo v resnici le nekaj
mutacij stran od katastrofe.
mutacij stran od katastrofe.
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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Da bi lahko cenili, kako temeljito
se HIV preobrazi vsakič,
se HIV preobrazi vsakič,
01:11
every time it reproduces,
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ko se podvoji,
01:12
let's make a genetic comparison.
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naredimo genetsko primerjavo.
01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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Če pogledamo variacijo človeške DNK
med različnimi rasami
med različnimi rasami
01:18
from different continents,
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z različnih kontinentov,
01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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je razlika med DNK le 0,1 odstotka.
01:24
If we look at the genetic difference
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Če pogledamo genetsko razliko
med ljudmi, velikimi opicami,
in rhesus opicami,
in rhesus opicami,
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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le ta znaša 7 odstotkov.
01:33
In contrast, the genetic difference
between HIV subtypes
between HIV subtypes
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Za primerjavo, genetska razlika
med podtipi HIV-a
med podtipi HIV-a
01:37
from different patients
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različnih pacientov
01:39
may be as much as 35 percent.
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je lahko tudi 35-odstotna.
01:42
Within a person infected with HIV,
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V osebi, okuženi z virusom HIV,
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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znaša genetska razlika
med prvotnim virusom okužbe
med prvotnim virusom okužbe
01:48
and subsequent daughter viruses
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in hčerinskimi virusi
01:50
has been shown to be
as much as five percent.
as much as five percent.
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tudi do pet odstotkov.
01:53
This is the equivalent of a gorilla
giving birth to a chimpanzee,
giving birth to a chimpanzee,
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To je enako, kot če bi gorila
rodila šimpanza,
rodila šimpanza,
01:58
then to an orangutan,
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potem orangutana,
01:59
then to a baboon,
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nato pavijana,
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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nato naključno veliko opico,
vse to v svojem življenju.
vse to v svojem življenju.
02:04
There are nearly 100 subtypes of HIV,
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Obstaja skoraj 100 podvrst HIV-a,
02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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ob tem pa redno odkrivamo nove podtipe.
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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HIV v razvitem svetu je skoraj ves
samo ene podvrste:
samo ene podvrste:
02:16
subtype B.
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Podvrste B.
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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Večina vsega, kar vemo in počnemo,
da bi pozdravili HIV,
da bi pozdravili HIV,
02:22
is based on studies on subtype B,
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je osnovana na študijah,
narejenih na podtipu B,
narejenih na podtipu B,
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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čeprav predstavlja le 12 odstotkov
02:28
of the total number
of cases of HIV in the world.
of cases of HIV in the world.
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vseh primerov virusa HIV na svetu.
02:33
But because of the profound
genetic difference
genetic difference
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Ampak zaradi pomembne genetske razlike
02:35
among different subtypes,
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med različnimi podtipi,
02:38
some subtypes are more likely
to become drug-resistant
to become drug-resistant
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je za nekatere podtipe bolj verjetno,
da bodo postali odporni na zdravila
da bodo postali odporni na zdravila
02:42
or progress to AIDS faster.
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ali hitreje napredovali v AIDS.
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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Odkrili smo, da se je eksplozija
primerov HIV-a na Filipinih
primerov HIV-a na Filipinih
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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zgodila zaradi premika
z zahodnega podtipa B
z zahodnega podtipa B
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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na bolj agresiven podtip AE
iz jugovzhodne Azije.
iz jugovzhodne Azije.
02:58
We are seeing younger and sicker patients
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Videvamo mlajše in bolj bolne paciente
03:01
with high rates of drug resistance.
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s pogostejšo rezistenco na zdravila.
03:04
Initial encroachment of this subtype
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Prvotna širitev tega virusa
03:07
is already occurring
in developed countries,
in developed countries,
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se že dogaja v razvitih državah,
03:09
including Australia,
Canada and the United States.
Canada and the United States.
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vključno z Avstralijo, Kanado
in Združenimi državami.
in Združenimi državami.
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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Morda bomo kmalu videli
eksplozijo primerov v teh državah.
eksplozijo primerov v teh državah.
03:19
And while we think that HIV is done
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In medtem ko mislimo,
da smo s HIV-om opravili
da smo s HIV-om opravili
03:22
and that the tide has turned for it,
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in da je val že odšel,
03:24
just like with real tides,
it can come right back.
it can come right back.
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se lahko kot pravi val spet vrne.
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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V 60-ih je bilo tako z malarijo.
03:31
As the number of cases dropped,
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Ko se je število primerov zmanjšalo,
03:33
people and governments
stopped paying attention.
stopped paying attention.
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ljudje in vlada niso bili več pozorni.
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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Rezultat je bila smrtonosna vrnitev
malarije, odporne na zdravila.
malarije, odporne na zdravila.
03:41
We need to think of HIV
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Ne smemo razmišljati o HIV-u,
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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kot o enem samem virusu,
ki ga dobro poznamo,
ki ga dobro poznamo,
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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ampak kot o skupini hitro
spreminjajočih se in unikatnih virusov,
spreminjajočih se in unikatnih virusov,
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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in vsak od njih lahko zaneti
naslednjo smrtonosno epidemijo.
naslednjo smrtonosno epidemijo.
03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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Vključujemo močnejša in novejša orodja
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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v iskanje naslednjega
smrtonosnega seva virusa HIV
smrtonosnega seva virusa HIV
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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in to mora biti z roko v roki
z nujnim raziskovanjem
z nujnim raziskovanjem
04:07
on the behavior and proper treatment
of non-B subtypes.
of non-B subtypes.
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delovanja in zdravljenja ostalih podtipov.
04:12
We need to convince our governments
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Prepričati moramo naše vlade
04:14
and our funding agencies
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in naše agencije za financiranje,
04:15
that HIV is not yet done.
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da s HIV-om še nismo opravili.
04:20
Over 35 million people have died of HIV.
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Več kot 35 milijonov ljudi
je umrlo zaradi HIV-a.
je umrlo zaradi HIV-a.
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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Smo na robu generacije brez AIDS-a.
04:28
We need to pay attention.
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Moramo biti pozorni.
04:30
We need to remain vigilant
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Moramo ostati oprezni
04:33
and follow through.
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in stvari izpeljati do konca.
04:34
Otherwise, millions more will die.
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Če ne, bo umrlo še na milijone ljudi.
04:37
Thank you.
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Hvala.
04:38
(Applause)
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(Aplavz)
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