Breakthrough study of 2011 and the tools for curbing HIV

The journal Science has named the HPTN 052 clinical trial, a study looking at the ability of antiretroviral medication to prevent HIV transmission, as the 2011 Breakthrough of the Year:

Led by study chair Myron Cohen, M.D., director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, HPTN 052 began in 2005 and enrolled 1,763 heterosexual couples in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe. Each couple included one partner with HIV infection. The investigators randomly assigned each couple to either one of two study groups. In the first group, the HIV-infected partner immediately began taking a combination of three antiretroviral drugs. The participants infected with HIV were extensively counseled on the need to consistently take the medications as directed. Outstanding compliance resulted in the nearly complete suppression of HIV in the blood (viral load) of the treated study participants in group one.

In the second group (the deferred group), the HIV-infected partners began antiretroviral therapy when their CD4+ T-cell levels—a key measure of immune system health—fell below 250 cells per cubic millimeter or an AIDS-related event occurred. The HIV-infected participants also were counseled on the need to strictly adhere to the treatment regimen.

It was found that those taking the medication while their immune system was still highly healthy were 96% less likely to transmit HIV to their partners. This result was so stupendous that, even though the trial is still ongoing, an early public release of the findings was ordered. It is important that people know how to best combat transmission. That spread of information is what is needed to prevent the spread of infection:

“On its own, treatment as prevention is not going to solve the global HIV/AIDS problem,” said Dr. Fauci. “Yet when used in combination with other HIV prevention methods—such as knowing one’s HIV status through routine testing, proper and consistent condom use, behavioral modification, needle and syringe exchange programs for injection drug users, voluntary, medically supervised adult male circumcision, preventing mother-to-child transmission, and, under some circumstances, antiretroviral use among HIV-negative individuals—we now have a remarkable collection of public health tools that can make a significant impact on the HIV/AIDS pandemic.”

“Scale-up of these proven prevention methods combined with continued research toward a preventive HIV vaccine and female-controlled HIV prevention tools places us on a path to achieving something previously unimaginable: an AIDS-free generation,” Dr. Fauci added.

I added the emphasis to the above excerpt because I am reminded of the utter irresponsibility displayed by PZ Myers on this issue in the past. While I still very much like what the guy has to say on many subjects, he was dead wrong to dismiss any one of the listed tools. In this case, he specifically dismissed the notion that there is any evidence whatsoever that circumcision has any impact on HIV infection rates. As I’ve documented elsewhere, he is absolutely wrong on the facts. That evidence does exist and it is important that it is known. That is why Dr. Fauci noted it amongst all the other ways we must use to combat this disease. HIV/AIDS is one of the most serious epidemics facing the developing world today; no one should be proud to exacerbate the problem, especially when the motivation is ideological in nature – we’re talking about god damned human lives here.

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The danger of false beliefs

A few months ago Wendy Pollack went to cause harm to people in Tanzania by providing them with false hope. She led sick people – specifically those with HIV – to believe that unproven and even blatantly discredited ‘medicine’ could help them become healthier. It was an awful tragedy and we can all be thankful that she has finally left Africa all together. She still practices her form of harm in America, but she at least faces some regulations here. (A complete outlawing of her shenanigans would be preferable.) It is easier to combat the misinformation of chiropractors and other sham-practitioners in a developed nation, even if they still manage to cause damage. Unfortunately, places like Tanzania do not have the institutions or medical infrastructure to implement procedures to protect its people, so even with people like Pollack safely thousands of miles away, alternative medicine practices still run rampant:

Hundreds of albinos are thought to have been killed for black magic purposes in Tanzania and albino girls are being raped because of a belief they offer a cure for AIDS, a Canadian rights group said on Thursday.

At least 63 albinos, including children, are known to have been killed, mostly in the remote northwest of the country.

“We believe there are hundreds and hundreds of killings in Tanzania, but only a small number are being reported to the police,” Peter Ash, founder and director of Under The Same Sun (UTSS), told Reuters.

This is a tragedy exactly along the same lines as what the entire alt-med crowd does. These random and inane – and often dangerous – faith-based ideas take off within a certain population and real human lives are put at risk. There is no evidence to back up any of these stupid and harmful beliefs, but evidence matters less and less as people get sicker and sicker. That’s one reason homeopaths are so successful in ripping people off.

What is happening in Tanzania right now rises to a level slightly above what most alt-med people do, but it really isn’t that far and away different. Remember Lawrence Stowe? He bankrupted sick people, drawing them away from real treatment. Many of those people died as a result of his actions – and he knew they would. Even where the people were terminal and could not be cured, he hastened death and increased pain. It’s standard practice for the alt-med crowd and I see no difference between that and what’s going on in Tanzania right now.

Vatican shifts on condoms

The Vatican has finally started to move in the right direction concerning condom use.

In a seismic shift on one of the most profound — and profoundly contentious — Roman Catholic teachings, the Vatican said Tuesday that condoms are the lesser of two evils when used to curb the spread of AIDS, even if their use prevents a pregnancy.

The position was an acknowledgment that the church’s long-held anti-birth control stance against condoms doesn’t justify putting lives at risk.

“This is a game-changer,” declared the Rev. James Martin, a prominent Jesuit writer and editor.

The new stance was staked out as the Vatican explained Pope Benedict XVI’s comments on condoms and HIV in a book that came out Tuesday based on his interview with a German journalist.

The Vatican still holds that condom use is immoral and that church doctrine forbidding artificial birth control remains unchanged. Still, the reassessment on condom use to help prevent disease carries profound significance, particularly in Africa where AIDS is rampant.

It would be nice if the next time I go to Africa, my travel doctor doesn’t specifically tell me, “Don’t have sex with the locals.” That’s a long way from happening, but at least the Vatican is doing less to make that dream stay so distant.

HIV: It’s still all about shape

The last time I wrote about HIV, I made the point that biology is all about shape; keep that idea in mind and a lot of things will suddenly start making a lot of sense. In that instance, I was writing about antibodies that were able to nearly universally attack HIV based upon one particular location on the virus which did not change shape. In this post I want to talk about a new study concerning protein differences.

To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and analyzed the effects of individual amino acids within the classical HLA proteins

HIV controllers are just what you probably think they are: they are people whose bodies are able to control the impact of HIV. They maintain healthy levels of helper T Cells. Progressors, on the other hand, are people who follow the expected course after they contract HIV. In this study, a large group of controllers were taken and had their genomes compared to progressor genomes. Researchers found more than 300 (313, to be exact) SNPs on the chromosome 6 that separated these two groups.

This is a pretty specific area with a small amount of difference. In fact, on the HLA-B protein, a difference of just 5 amino acids makes all the difference in a single groove. It appears as though this is one of the most important differences between controllers and progressors, constituting a significant region which enables the immune system to control and limit the proliferation of HIV. The amino acid sequence changes the shape of the groove in controllers as compared to progressors. This change protects the controller against HIV and its deadly consequences.

Precisely how this change in shape keeps HIV from turning into AIDS has not yet been made clear, but it is very promising. Given the current state of research, I’m willing to predict we’ll see a cure for HIV before we see a cure for cancer.

The fight against HIV

In biology, it’s all about shape. Enzymes, proteins, antibodies, blood vessels, cells, everything. They work best when they fit best or match in shape best. That’s why two new HIV antibodies have such potential.

Scientists report they’ve discovered possible new weapons in the war against HIV: antibody “soldiers” in the immune system that might prevent the AIDS virus from invading human cells.

According to the researchers, these newly found antibodies connect with and neutralize more than 90 percent of a group of HIV-1 strains, involving all major genetic subtypes of the virus.

That breadth of activity could potentially move research closer toward development of an HIV vaccine, although that goal still remains years away, at best, experts say.

HIV molecules evolve at a rapid pace. This makes it nearly impossible to produce antibodies at rates and in quantities sufficient to combat the disease on a long-term basis. However, there is one part of an HIV virus which remains virtually unchanged. This is important because it means there is a site with a consistent shape on the virus. That’s where these antibodies are being directed, thus offering a potentially powerful new tool in the fight against HIV.

Explaining denialism

It’s ever so common to come across an evolution denier only to discover the person is also a global warming denier. This may be chalked up to ideology – American conservatism practically demands a god and it’s too pro-business to accept the science of global warming (or at least the predicted consequences). But another reason must often be sought; the denialism can extend beyond a conservative agenda. This includes HIV denial, vaccine denial, second-hand smoke denial, and a host of other forms. In fact, the anti-vax movement will often find sympathies on the left.

Some of the common underlying themes of denialism are alleging conspiracies, moving the goalposts in the face of evidence, and manufacturing evidence. In other words, it’s all very anti-scientific. But it isn’t necessarily an outright hostility towards science that causes this – though many conservatives suffer from such an affliction. Instead, it’s the way many people tend to think.

All denialisms appear to be attempts like this to regain a sense of agency over uncaring nature: blaming autism on vaccines rather than an unknown natural cause, insisting that humans were made by divine plan, rejecting the idea that actions we thought were okay, such as smoking and burning coal, have turned out to be dangerous.

This is not necessarily malicious, or even explicitly anti-science. Indeed, the alternative explanations are usually portrayed as scientific. Nor is it willfully dishonest. It only requires people to think the way most people do: in terms of anecdote, emotion and cognitive short cuts. Denialist explanations may be couched in sciency language, but they rest on anecdotal evidence and the emotional appeal of regaining control.

Emotional appeals are not always bad. When they are mixed with substance, they make for powerful rhetoric. But often, entire arguments are premised in emotion. Take creationism/intelligent design. It isn’t that there’s any evidence for it; many people recognize that natural selection is a blind process which builds piece by piece, bit by bit, thereby not being random and not being improbable, thus making all life the product of purely natural processes. God has no place to go but out. Since no science supports creationism/intelligent design, an emotional response is the result – to the detriment of science.

[Seth Kalichman of the University of Connecticut at Storrs] believes the instigators of denialist movements have more serious psychological problems than most of their followers. “They display all the features of paranoid personality disorder”, he says, including anger, intolerance of criticism, and what psychiatrists call a grandiose sense of their own importance. “Ultimately, their denialism is a mental health problem. That is why these movements all have the same features, especially the underlying conspiracy theory.”

Neither the ringleaders nor rank-and-file denialists are lying in the conventional sense, Kalichman says: they are trapped in what classic studies of neurosis call “suspicious thinking”. “The cognitive style of the denialist represents a warped sense of reality, which is why arguing with them gets you nowhere,” he says. “All people fit the world into their own sense of reality, but the suspicious person distorts reality with uncommon rigidity.”

The likes of Maloney and Moritz certainly fit this profile. Both have had some of the most radical reactions to criticism I’ve seen since grade school, they both are clearly angry (especially Maloney), and both actually have taken measures to expand their web presence upon its destruction by Pharyngula and FTSOS (Moritz on Facebook, Maloney everywhere else), apparently believing what they have to say is too important to be drowned out by facts, evidence, and other pesky things.

But this extends beyond those two. Many creationists fit this profile. Just wait for one to write an editorial to a paper. The emotion, the anger. Then respond. Watch for the screeching about tone, respect, not being nice enough. And I don’t mean to watch for those reactions from my style of writing (though I get those, too). The most tempered response is met with hostility.

But as damaging as denialism has been to science education, it has had more immediate, more serious consequences.

Denialism has already killed. AIDS denial has killed an estimated 330,000 South Africans. Tobacco denial delayed action to prevent smoking-related deaths. Vaccine denial has given a new lease of life to killer diseases like measles and polio. Meanwhile, climate change denial delays action to prevent warming. The backlash against efforts to fight the flu pandemic could discourage preparations for the next, potentially a more deadly one.

If science is the best way to understand the world and its dangers, and acting on that understanding requires popular support, then denial movements threaten us all.

Science is, in fact, the best way of knowing.

The incoherent ramblings of Andreas Moritz

One positive that immediately came from Andy Moritz whining about my Facebook fan page of him is that I know he still reads this blog. I never directly sent him any of the information about the page, so unless he happened to go searching for himself within hours of me creating it, then he got his information here. That’s swell because now he can read this. (Hi, Andy!)

Moritz often says the most incoherent bullshit. The man is a moron with no grasp on anything. This holds especially true for the basics of biology.

When one or more amino acids become depleted, DNA or RNA molecules break apart, leaving behind their protein fragments labeled HIV.

This doesn’t make any sense whatsoever. It’s likes he found a few buzzwords in the glossary of a biology textbook and just randomly strung them together. Is he saying amino acids are proteins? Or does he mean DNA/RNA? Either way he’s as wrong as his syntax. And is he saying HIV is a protein? The quack is utterly incoherent.

But there’s more. This is from his shitty fan page.

Exercise to only half your capacity. Tiring yourself only defeats the very purpose. Exercise is supposed to make you feel refreshed, revitalized and energetic. As you proceed, your capacity for exercise will naturally increase.

Exactly. Exercise should be a walk in the park. It ought to be easy, untiring, and not even feel like exercise. That’s how all those people in infomercials get the way they are. They really just half-ass it and suddenly get buff as hell. Wait, what? Why doesn’t anyone believe me? Fine, don’t take my word for it. Andreas Moritz is the one with all the muscles (and not gaunt and weak or anything*).

One the most important discoveries ever made about man’s number one killer disease is rarely mentioned in reports on heart disease and its contributing risks, but this doesn’t make it less real. The greatest risk factors of developing heart disease are job satisfaction and the happiness rating.

Really? Where are your studies? Where is all the evidence? The moron doesn’t have any. This is just his ill-begotten opinion. He knows nothing.

If you want to help a sick person but do not know how, hold his/her hand in yours. This does more to help the person’s condition than any amount of sympathetic words could do.

This pretty much captures this guy. He doesn’t actually help anyone. And while he holds someone’s hand, he has his other hand in that person’s wallet. The condition of greed and deceit under which Moritz lives is greatly helped by this, far more so than any amount of sympathetic words could do.

*If you delete that picture, Andy, I have it saved and will upload it so we can all have yet another chuckle at your expense.