TEDGlobal 2017
Edsel Salvaña: The dangerous evolution of HIV
Edsel Salvaña: 人類免疫缺陷病毒嘅危險進化
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覺得我哋已經贏咗人類免疫缺陷病毒（HIV）？可能唔係，因為下一波抗藥性變異病毒浪潮即將到來。喺一場別開生面嘅 TED 演講中，TED 講者 Edsel Salvaña 講述強勁嘅 HIV AE 亞種正在肆虐佢嘅祖國菲律賓。佢警醒我哋輕易觸發一種全球性傳染病嘅可能因素。
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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菲律賓係一個田園國家
00:15
with some of the clearest water
and bluest skies on the planet.
and bluest skies on the planet.
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擁有地球上最乾淨嘅水和最藍嘅天空
00:19
It is also the epicenter
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同時都係世界上
00:20
of one of the fastest-growing
HIV epidemics in the world.
HIV epidemics in the world.
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HIV 傳染病例增長最快嘅重災區之一
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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表面上睇，菲律賓
似乎只係一個遲爆發 HIV 嘅國家
似乎只係一個遲爆發 HIV 嘅國家
00:28
However, the reasons
for our current epidemic
for our current epidemic
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但係，事實上造成我哋疫情嘅原因
00:31
are much more complicated
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要複雜得多
00:33
and may foreshadow
a global resurgence of HIV.
a global resurgence of HIV.
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而且疫情可能預示著
HIV 會再次喺全球爆發
HIV 會再次喺全球爆發
但全球 HIV 總體新病例數
正持續下降
正持續下降
00:38
While overall new cases of HIV
continue to drop in the world,
continue to drop in the world,
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00:42
this trend may be short-lived
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呢個趨勢可能唔會持續
00:45
when the next wave of more aggressive
and resistant viruses arrive.
and resistant viruses arrive.
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但係，下一輪嘅病毒
將會更強烈、抗藥性更强
將會更強烈、抗藥性更强
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 HIV 侵染一個細胞
佢都可能將自己變異成一種新病毒
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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雖然我哋同 HIV 傳染病嘅仗
已經取得顯著進展
已經取得顯著進展
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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事實上，只要病毒再變異幾次
災難就可能會再次來襲
災難就可能會再次來襲
01:07
To appreciate the profound way
in which HIV transforms itself
in which HIV transforms itself
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為咗更加清楚咁瞭解
HIV 每次增殖后顯著嘅基因變異
HIV 每次增殖后顯著嘅基因變異
01:11
every time it reproduces,
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01:12
let's make a genetic comparison.
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我哋嚟做一個基因對比
01:15
If we look at the DNA variation
among humans of different races
among humans of different races
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如果我哋去睇各個大洲
唔同人種之間嘅 DNA 多樣性
01:18
from different continents,
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01:20
the actual DNA difference
is only 0.1 percent.
is only 0.1 percent.
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事實上只有百分之零點一嘅差別
01:24
If we look at the genetic difference
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如果係人類、人科猿、 普通獼猴三者
01:26
between humans, great apes,
and rhesus macaques,
and rhesus macaques,
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基因差別係百分之七
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，喺唔同病人身上嘅 HIV 亞種
01:37
from different patients
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基因差別會高達百分之三十五
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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同一個 HIV 患者身上
01:44
the genetic difference
between an infecting mother virus
between an infecting mother virus
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親代同子代病毒之間嘅基因差異
01:48
and subsequent daughter viruses
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有百分之五噉多
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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親子代之間噉大嘅基因變異
就相當於大猩猩生黑猩猩
就相當於大猩猩生黑猩猩
01:58
then to an orangutan,
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再生紅猩猩
01:59
then to a baboon,
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然後生狒狒
02:01
then to any random great ape
within its lifetime.
within its lifetime.
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又再喺生命之中生任何一種人猿
02:04
There are nearly 100 subtypes of HIV,
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HIV 病毒有將近一百個亞種
02:08
with new subtypes
being discovered regularly.
being discovered regularly.
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仲有新亞種被持續發現
02:11
HIV in the developed world
is almost all of one subtype:
is almost all of one subtype:
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發達國家嘅 HIV 幾乎
都係同一個亞種︰
都係同一個亞種︰
02:16
subtype B.
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B 亞種
02:18
Mostly everything we know
and do to treat HIV
and do to treat HIV
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我哋對 HIV 一切嘅瞭解同治療
02:22
is based on studies on subtype B,
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幾乎都係基於對 B 亞種嘅研究
02:26
even though it only
accounts for 12 percent
accounts for 12 percent
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雖然佢只占全世界 HIV 病例
嘅百分之十二
嘅百分之十二
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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但由於唔同亞種之間
顯著嘅基因差異
顯著嘅基因差異
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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一啲亞種產生抗藥性嘅可能性會更高
02:42
or progress to AIDS faster.
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甚至會更快發展成愛滋病
02:44
We discovered that the explosion
of HIV cases in the Philippines
of HIV cases in the Philippines
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我哋發現菲律賓嘅 HIV 病例嘅爆發
02:49
is due to a shift
from the Western subtype B
from the Western subtype B
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係由於西部 B 亞種
02:53
to a more aggressive
Southeast Asian subtype AE.
Southeast Asian subtype AE.
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變異成一種更強勁嘅
東南亞 AE 亞種
東南亞 AE 亞種
02:58
We are seeing younger and sicker patients
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我哋發現更後生、病情更嚴重嘅病人
03:01
with high rates of drug resistance.
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有更高嘅抗藥性比率
03:04
Initial encroachment of this subtype
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呢個亞種已經入侵發達國家
03:07
is already occurring
in developed countries,
in developed countries,
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03:09
including Australia,
Canada and the United States.
Canada and the United States.
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包括澳洲、加拿大同美國
03:13
We may soon see a similar
explosion of cases in these countries.
explosion of cases in these countries.
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可能好快，類似菲律賓嘅 HIV 疫情
就會喺呢啲國家發生
就會喺呢啲國家發生
03:19
And while we think that HIV is done
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如果我哋以為 HIV 大潮已經退去
就錯啦
就錯啦
03:22
and that the tide has turned for it,
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事實上佢會返嚟
03:24
just like with real tides,
it can come right back.
it can come right back.
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就好似真正嘅潮水會回潮
03:27
In the early 1960s,
malaria was on the ropes.
malaria was on the ropes.
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十八世紀六十年代早期
瘧疾大潮消退
瘧疾大潮消退
03:31
As the number of cases dropped,
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病例數下降
03:33
people and governments
stopped paying attention.
stopped paying attention.
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人們同政府轉移咗注意力
03:36
The result was a deadly resurgence
of drug-resistant malaria.
of drug-resistant malaria.
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結果抗藥性瘧疾又捲土重來
03:41
We need to think of HIV
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我哋唔可以將 HIV 睇成
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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一種已經瞭解透徹嘅單一病毒
03:46
but as a collection of rapidly evolving
and highly unique viruses,
and highly unique viruses,
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而係一系列進化快速、高度獨特嘅病毒
03:53
each of which can set off
the next deadly epidemic.
the next deadly epidemic.
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其中任何一種都有可能
引發下一次致命嘅疫情
引發下一次致命嘅疫情
03:56
We are incorporating
more powerful and new tools
more powerful and new tools
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依家我哋藉助更強大、更新嘅工具
04:00
to help us detect
the next deadly HIV strain,
the next deadly HIV strain,
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去檢測下一個致命 HIV
04:03
and this needs to go hand in hand
with urgent research
with urgent research
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噉又需要同時進行
對非 B 亞種嘅緊急研究同適當治療
對非 B 亞種嘅緊急研究同適當治療
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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我哋需要令我哋嘅政府、基金會相信
04:14
and our funding agencies
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04:15
that HIV is not yet done.
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人類同 HIV 嘅惡戰仍未結束
04:20
Over 35 million people have died of HIV.
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超過三千五百萬人死於 HIV
04:25
We are on the verge
of an AIDS-free generation.
of an AIDS-free generation.
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我哋將邁入「零愛滋」嘅年代
04:28
We need to pay attention.
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我哋需要時刻關注
04:30
We need to remain vigilant
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我哋需要保持警惕，及時跟進
04:33
and follow through.
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04:34
Otherwise, millions more will die.
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唔係嘅話，仲會有千千萬萬個人喪生
04:37
Thank you.
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多謝
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