Amid the advances in the treatment of human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS)—with HIV+ (positive) individuals expecting an almost similar long-term outcome as those with hypertension and diabetes—can we rest assured that the battle against this dreaded disease is being finally won?

Not quite, according to Dr. Edsel Salvaña, an infectious disease specialist and molecular epidemiologist. He’s one of the few scientists in Asia doing advanced biomolecular or genomic studies to determine the mutation of the virus causing AIDS.

If we’re not vigilant, warned Edsel, we just might be a few mutations away from a resurgence of the AIDS virus.

Two weeks ago, Salvaña and I were invited to lecture on separate topics in a summit for internal medicine specialists practicing in various parts of the country organized by LRI-Therapharma. But Salvaña’s topic was the more interesting eye-opener, as he reported that even some doctors and healthcare professionals have gotten infected, likely because of their exposure to the blood of people who have the virus.

In the emergency or operating room, when there’s a patient with a gushing wound or injury, some doctors and nurses may fail to take all the precautionary measures in their rush to attend to the patient.

So, it’s good and bad news on the HIV front.

The good news is, with available treatment, many diagnosed HIV+ cases can expect to live an almost normal life—with some precautions, of course.

Salvaña explained that HIV+ individuals who are under treatment can have their virus load suppressed to such a level that they can safely have sexual relations with their spouses with an almost zero risk of transmitting the virus.

For practical purposes, it’s actually zero, since it would take more than 120 years of regular sex to transmit the virus.

Practically zero

Salvaña assured that even surgeons who have effectively suppressed virus levels can still perform operations, because the risk of transmitting the virus is practically zero.

There should be no moral qualms about not disclosing it to their patients, but they should be responsible enough to have themselves checked regularly to make sure their virus levels remain suppressed.

The other good news is, the cost of maintenance treatment for HIV is cheap. Actually, the Department of Health offers free treatment. And the cost of medicine is even lower than those for other diseases like chronic lung ailment, heart disease and diabetes.

There’s an optimistic prospect that HIV could become an ordinary chronic illness very similar to hypertension and diabetes. But that’s as far as the good news about HIV/AIDS goes.

Although the actual number of Filipinos with HIV/AIDS is still much smaller compared to neighboring countries like Thailand, the trend is very alarming.

From only one to two new cases diagnosed daily several years ago, it has ballooned to more than 30. The country is now the epicenter of one of the fastest-growing HIV epidemics in the world, said Salvaña.

“On the surface, it seems as if we are just a late bloomer. However, the reasons for our current epidemic are much more complicated and may foreshadow a global resurgence of HIV,” he emphasized.

Epidemiologists thought we’d seen the worst of HIV/AIDS with the overall global trend showing a continuing drop of newly diagnosed cases.

But Salvaña painted a not too-rosy outlook: “This trend may be short-lived when the next wave of more aggressive and resistant viruses arrive. HIV has a potential to transform itself into a new and different virus every time it infects a cell. Despite the remarkable progress we’ve made in reversing the epidemic, the truth is that we are just a few viral mutations away from disaster,” he explained in the video presentation he did for TED Talks last year.

Disbelief

The manner in which HIV mutates can make scientists like Salvaña shake their heads in disbelief. To illustrate, he made a genetic comparison of the DNA variation among humans of different races, and the actual interracial DNA difference is only 0.1 percent. Comparing humans and apes, it’s around seven percent.

“In huge contrast, the genetic difference between HIV subtypes from different patients may be as much as 35 percent,” he said.

And in the same patient infected with HIV, the genetic difference between the infecting original virus and the subsequent ‘daughter viruses’ has been demonstrated in genomic studies done by Edsel and his fellow scientists to be as much as five percent. It’s almost incredible.

“This is the equivalent of a gorilla giving birth to a chimpanzee, then to an orangutan, then to a baboon, then to any random great ape within its lifetime,” explained Salvaña, who heads a team using next-generation sequencing and other cutting-edge genetic tools to study HIV viral diversity and super-infection.

To date, nearly 100 subtypes of HIV have been discovered, and new subtypes keep adding to the list.

The newer subtypes are more likely to become drug-resistant or may progress to AIDS faster. And at the rate that the virus is mutating, we may not be able to catch up in finding new treatments.

Sometime ago, health authorities reported that many new cases come from the ranks of call center employees. Saldaña said they are seeing younger and sicker patients with high rates of drug resistance.

This different subtype is also now reported in developed countries, like Australia, Canada and the United States. This may indicate a new wave or resurgence of cases in these countries.

If our health officials and citizenry become
complacent and think we’ve already figured out how to curb HIV/AIDS, we may be in for a big surprise. Everyone has to remain vigilant.

He stressed the importance of urgent research. Governments and funding sources must recognize this and allocate the necessary resources.

With more than 35 million people already dead from HIV/AIDS, and scores diagnosed to be HIV+, the future still looks uncertain.

It can swing both ways—
either we become AIDS-free, or massively AIDS-afflicted with no known effective treatments for the mutated forms.

Dr. Edsel Salvaña is the director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines. He spearheaded the formulation of HIV treatment guidelines, raising public awareness on prevention and campaigning against the stigma on individuals discovered to be HIV+. Watch Edsel’s TED Talk at: ted.com/talks/edsel_salvana_the_dangerous_evolution_of_hiv#t-2139.