Resources: Global Strategies for HIV PreventionA pioneer in the world of HIV and AIDS research discusses how our understanding of the illness has changed and his work on prevention and treatment around the world.
GUEST: Arthur Ammann (MD) is president of Global Strategies for HIV Prevention and Clinical Professor of Pediatrics at the University of California, San Francisco Medical Center.
This is the chat transcript.
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Comments: 38
Note to all: Publicly posted questions get priority. I will work in questions sent via other methods as able.
Is there a possible way to manipulate the mutations of the HIV/AIDs virus and then
vaccinate people according to such a mutation?
Dr. Ammann replied:
Yes, one can genetically engineer the virus so it has a mutation that makes it less effective. This was suggested about 10 years ago, when they discovered some patients that got blood tranfusions that had HIV but 10 or 12 years after, had no symptoms of AIDS.
The problem with that is it would be a live virus and the concern is that 20 years later the patient would progress to AIDS.
So the idea was abandoned.
also what about humanized antibodies - what are people thinking of the success of this approach- I think we have been too focused on a vaccine
What's the rate of contagion between child TO adult? That is, are the caregivers of children with HIV/AIDS at great risk?
Dr. Ammann replied:
We know of NO instance that a caregiver of a child has gotten HIV infection and the reason for tha tis that it requires more direct innoculation of the virus, either by accidental innoculation or by sexual transmission.
Nurses and physicians that take care of HIV patients can get infected by accidental innoculation, but we do have anti-retro-viral drugs that can protect them from becoming infected.
So for the the health care worker it is extremely rare to become infected, and we know of no parental infection.
Where can I find more information about the stats that circumcision causes a 40% reduction in HIV infection?
Dr. Ammann replied:
You should go to the Web site womenchildrenhiv.org and just put in search circumcision and you'll find the articles.
My question concerns whether we can look to other areas of research to find new ways to attack HIV, for example, new discoveries relating to microRNA seem to indicate these molecule control gene expression and may play a role in cancer- has anyone been looking at microRNa profiles of virus infected cell or even of immune cells from virus infected people
also what about humanized antibodies - what are people thinking of the success of this approach- I think we have been too focused on a vaccine
Dr. Ammann replied:
The answer is yes, peop0le are looking at very radical approaches. There's an article in Science where they listed some 20 target for drug and vaccine research. And so it is very important to incorporate other fields of science in research.
The difficulty with humanized antibodies is that they don't have extensive repetoire that a human can produce by themselves so it is unlikely that an antibody could be broad enough to control the activity of a highly mutating virus.
We are mistakenly taught that monogamy keeps us safe. How do we convince people that if sexually active they are at risk and should be tested?
Dr. Ammann replied:
This is an issue of how we present the public health message to people in general. One of the approaches we suggest is that HIV testing should be universal. That is everyone should be offered the test, without any assumptions being made about HIV infection.
For example, in the U.S. surveys have been done and almost 1/2 of the women who where tested and HIV positive were unaware of their infection, because they felt they were monogamous, but their sexual partner was not.
It seems as though we are limited in our abilities to fight viruses, I've only heard of vaccinations. Are there other ways to fight off viruses?
Dr. Ammann replied:
Yeah, because of HIV and the related reseach we have anti-viral drugs for virus other than HIV. The best example is the drugs to treat the herpes virus. We also have drugs to treat CMV virus, which is a virus that affect people with cancer, young babies.
We need to focus on a cure otherwise the virus will continue to mutate and spread. This is
severely underestimated virus.
Dr. Ammann replied:
The feeling is that a cure is a very difficult goal, but correctly it should be a focus of treatment. The point is that these long term, more elusive goals, while we work towards them we have to work toward them, like you said. Since we can't cure, we have to work to prevent.
Dr. Ammann, you mentioned during the show that you were banking on some bright young scientist thinking outside the box. While I hear your thoughts on that, I have to wonder about the new generations using untraditional methods to arrive at solutions.
Considering communication and collaboration tools on the Internet, do you think that medical research is evolving, or cyclical?
Dr. Ammann replied:
We've got to be careful about technical solutions to big problems like HIV, although they are important tools and have resulted in our learning more about HIV than any other virus... the intellectual thought about how to make a vaccine will probably come from a young mind and not technology.
Houston Doctors May Have Found HIV Cure I was a call in on the HIV show this morning.
Here is a link to better explain what I was talking about.
http://www.truthout.org/article/houston-doctors-may-have-found-hiv-cure
Cheers, KC
Dr. Ammann replied:
Because the virus is capable of mutating around new drugs as well as around immune responses, that even if there's a consistent region of the virus now, there's still a possibility that it would evolve and could not be controlled.
Worth looking at, but I would not be too optimistic.
cynically spoken, to be sure
Dr. Ammann, you speak out on prevention and the importance of contact tracing and the stigma surrounding HIV|AIDS. Do you think that contact tracing can ever be mandated, or do you think that we'll evolve socially in time to pursue it?
Dr. Ammann replied:
I don't think it could ever be mandated, but I think if you look at the evolution with what's happened with HIV testing over the last 20 years, we're moving towards a more aggressive and universal approach in testing.
What needs to be done is to educate individuals who are infected about transmission. Not through mandated efforts, but through individual responsibility.
It sounds as though you think AIDS is worse than other fatal disease such as cancer. Am I hearing you correctly? And if so, why do you think that AIDS is more serious? After all, it's all fatal in the end. cynically spoken, to be sure
Dr. Ammann replied:
Uhmmm because HIV infection brings in many more community, social and political issues than chronic diseases like cancer, tuberculousis, and malaria. So an HIV infected individual will disrupt the family structure. It is introduced to the community as a chronic disease that requires a lot of medical care and expense. Affecting sexual partners, children.