Worst Place to Receive HIV Treatment?
Science magazine’s Jon Cohen speaks with Jackie Judd of the Kaiser Family Foundation about preliminary science that may show why East Africans could be at a disadvantage when being treated for HIV. Read the full transcript below the video.
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Jackie Judd, Kaiser Family Foundation: Jon Cohen of Science magazine, welcome back, as always.
Jon Cohen: Thanks, Jackie.
Judd: Today you spent some time looking at some fascinating but early science — strangely involving Minnesotans and Ugandans.
Cohen: Yeah, and it’s really fascinating because it’s a study presented yesterday that linked to another study that I found today. And they weren’t done by the same people or anything. But they have overlap that I think is fascinating. The group yesterday looked at the lymph nodes of people in Uganda and people in Minnesota. The lymph node is where the CD4 cells live — a lot of them live. The CD4 cells are the very cells HIV targets and destroys. So they’re the heart of the HIV problem. What they found is in Uganda, people who didn’t have any HIV, their lymph nodes had junk in there — fiber junk — clogging it up, which makes it difficult for the CD4 cells to talk to each other and to hear each other. In Minnesota, they looked at HIV in uninfected people and there was nothing like that — they were clean. The architecture was normal. When they looked at HIV-infected people in Minnesota who were on good drugs, they looked like the uninfected people in Uganda. They had the same sort of cluttered architecture.
Judd: Do scientists know yet what to make of that?
Cohen: They have an interesting theory. And the theory is that in eastern Africa, people are assaulted with all sorts of pathogens that aren’t in North America: malaria, there are helminthic infections, there are all these bugs that people are constantly having to confront. And their theory is that their immune systems are constantly inflamed and that’s what’s leading to an HIV-state in people who are treated, who have, as we well know, some inflammation still.
Judd: Now tell us about the second one.
Cohen: So the second study is an enormous study – almost 30,000 people. It’s led by a group from the University of California, San Francisco, but it involves international collaboration. And what it asks is when people go onto antiretroviral treatment, how much do their CD4 cells rebound? They looked all over the world, and everywhere it looks about the same except for one place: eastern Africa. So it raises a really provocative question. What’s going to happen over time in eastern Africa for people on treatment? Are they going to get the same benefit as people in the rest of the world? Or are they possibly not going to have the immune reconstitution that everyone else enjoys because of the environment they live in?
Judd: So then ultimately — I’m mixing the two studies now. The people in Minnesota who are HIV-positive and are on medications could ultimately be in better health than the people in eastern Africa — also who are positive and on medication. Is that the thinking?
Cohen: That’s the scary proposition, yeah. And we don’t have enough data yet. Not enough time has passed. People in eastern Africa started on antiretrovirals in 2003, 2004. People in North America started on good drugs in ’96. So we’ve had enough time to say, ‘You can live for — we can extrapolate — for 40, 50, 60 years, with good medication.’ We don’t know that yet for eastern Africa.
Judd: So what happens from here — from the AIDS 2012 Conference. Do these scientists continue pursuing it? Do they hope that other scientists here pick it up and run with it? What’s next?
Cohen: Well, let’s say this theory is true. What you want to do is reduce inflammation. So maybe what you need to do — in addition to treating HIV infection — is you need to treat inflammation. That will require new scientific studies and really creative approaches to dealing with a problem that isn’t HIV specific.
Judd: OK, as I said at the top, fascinating. Thank you, Jon Cohen.
Watch this week’s speeches from the International AIDS Conference in their entirety here or on the NewsHour’s Health Page. Also there, find background materials including a primer on this week’s conference in Washington and a look at how the HIV/AIDS fight in the District of Columbia itself compares with a nation in sub-Saharan Africa on three fronts: assisting orphans, preventing the spread of HIV in correctional facilities and reducing stigma in churches.