ACT-UP! The HIV and TB Pandemics

HIV-1 (in green) budding from cultured lymphocyte; Source: CDC

Hi Everyone,

I'm glad to see that you all enjoyed Peter's lecture this week.  He really knows his stuff on HIV and TB! 

Regarding the former, "And the Band Played On" is an excellent book (1987) by the late Randy Shilts (and 1993 HBO film starring Matthew Modine and Alan Alda) that chronicles the early days of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) epidemic and the social, political, and science issues confronting the world when so little was understood about the nature of this infectious disease.  More recently is "How to Survive a Plague," the Academy Award

Brian Fitzgibbon and Jim Herrington, Peace Corps Senegal, 1980

Nominee for Best Documentary about "two coalitions—ACT UP and TAG (Treatment Action Group)—whose activism and innovation turned AIDS from a death sentence into a manageable condition."  Unfortunately, the tide was not turned soon enough to save my good friend and Peace Corps colleague, Brian Fitzgibbon, who died of AIDS in 1993, just before antiretroviral therapies (ARTs) became widely available.

Although AIDS is now considered a chronic disease, because drug therapy is affordable and works, the prevention of new cases (incidence) is challenging, given the preventive choices in most low-income countries are still the ABCs = abstinence, be faithful, and condoms, with an  additional "C" for men = male circumcision.   Further, the "Vaginal and Oral Interventions to Control the Epidemic" or VOICE Trial was hoped to provide an antimicrobial vaginal gel and oral tablets that would prevent HIV infection.  Unfortunately, the trial was stopped because trial participants were not actually taking the oral or gel products, even though they self-reported adherence when asked by research managers.  This is not unlike what is termed social desirability bias in research, where participants tell the researchers one thing, while actually behaving in a manner discordant to their verbal statements.

TB prevention campaign poster from the 1920s

Tuberculosis, the second disease Peter discussed during his lecture, is a much more worrisome infection than HIV, given roughly 1/3 of the world's population is infected with the mycobacterium that causes TB and because it it spread by the respiratory route of exposure. A single sneeze can release up to 40,000 aerosol droplets 0.5 to 5.0 µm in diameter.  Sal Khan of Khan Academy fame, gives a clear, short description of the symptoms of and mechanisms of exposure to TB.

Prior to the advent of modern antibiotics, as shown in this health film from the UK, TB was treated in sanatoriums which offered collapsed lung therapy, isolation to prevent the spread of the disease, fresh air, sunshine, and rest.  Modern drugs now permit successful treatment of TB, sans sanatorium.  However, the patient must be adherent to the treatment regimen and not quit therapy early.   If not, multi-drug resistant tuberculosis (MDR-TB) results, which is much more costly and difficult to treat, but not impossible, as described in this short film, narrated by actor Brad Pitt, about Partners In Health's successful efforts in Lima, Peru.   

Cover that cough in your elbow and wash your hands with soap and water after sneezing!

Jim

Proportion of MDR-TB among new TB cases, 1994-2012; Source: WHO http://www.who.int/tb/challenges/mdr/en/