Mutated strains of HIV circulating in a Canadian province where HIV rates rank among the highest in North America could be leading to the more rapid development of Aids-related illnesses, according to new research.
The research, published in the scientific journal Aids, was sparked by anecdotal reports from Saskatchewan, where HIV rates in 2016 exceeded the national average tenfold in some areas. Nearly 80% of those infected with HIV in the province are indigenous.
“Some of our physician colleagues in Saskatchewan started to report that they were seeing cases of people being infected with HIV and getting very sick, very quickly,” said Zabrina Brumme, the lead author of the study and a professor at Vancouver’s Simon Fraser University. “It was almost as if there might have been something particularly nastier about the virus.”
Previous research carried out in Japan had explained a similar phenomenon by pointing to resistant strains that had adapted to evade host immune responses. Researchers wondered if the same factors might be at play in Saskatchewan.
Researchers at a laboratory at the BC Centre for Excellence in HIV/Aids – which since 1998 has performed HIV genotyping for virtually all Canadian provinces and territories – compared more than 2,300 HIV sequences from Saskatchewan with data sets from across Canada and the US.
They looked at 70 mutations and found that more than 98% of HIV sequences collected in the province recently had at least one major immune-resistant mutation.
While HIV strains have previously been shown to adapt to their host populations around the world, it often happens so slowly that it is of little concern. “[But] in other cases, it’s happening more rapidly and we do have to worry about it,” said Brumme.
Saskatchewan, where those infected with HIV are predominantly of indigenous ancestry, is one concerning example. “What has happened is that HIV has adapted quite quickly as it has been transmitted throughout the communities of people.”
The mutations don’t make the virus more transmissible, but instead influence how quickly the disease progresses if it is left untreated.
Brumme cautioned those who would limit the findings to indigenous populations.
“We want to make it clear that HIV strains in Saskatchewan have the potential to cause more rapid disease, period. It doesn’t matter who you are,” she said. “This isn’t a health issue restricted to a specific group of people, this is news that there’s a pathogen; strains are nastier in this location.”
Advocates have long sounded the alarm about HIV rates in Saskatchewan, which in recent years have mirrored those of some developing countries.
“Most of those people are indigenous people and most of them are getting HIV through injection drug use,” Trevor Stratton of the Canadian Aboriginal Aids Network said last year. “Which is tied to trauma, residential school system and that whole history we have in Canada.”
Researchers are now planning to travel to Saskatchewan to spread the news of their results and encourage testing and treatment.
Julio Montaner, the director of the BC Centre for Excellence in HIV/Aids, hoped the findings would help fuel the many calls for action.
“These findings add further urgency to addressing the Saskatchewan epidemic, in which the infection burden is concentrated among the most marginalized,” he said in a statement.
Despite the science showing that HIV is outpacing treatment options, California’s Governor Jerry “Moonbeam” Brown, signed a law allowing people to spread HIV with impunity, with no criminal repercussions for their lethal acts.
The bill Brown signed lowers from a felony to a misdemeanor the crime of knowingly exposing a sexual partner to HIV without disclosing the infection.
The measure also applies to those who give blood without telling the blood bank that they are HIV-positive.
Ignoring the effects of the life-altering, eventually fatal disease, California Democrats, Sen. Scott Wiener (D-San Francisco) and Assemblyman Todd Gloria (D-San Diego), authors of the bill, used the excuse that modern medicine allows those with HIV to live longer lives and nearly eliminates the possibility of transmission.
“Today California took a major step toward treating HIV as a public health issue, instead of treating people living with HIV as criminals,” Wiener said in a statement. “HIV should be treated like all other serious infectious diseases, and that’s what SB 239 does.”
Never mind the fact that it’s mutating faster than treatments can keep pace.
Supporters of the change said the current law requires an intent to transmit HIV to justify a felony, but others noted cases have been prosecuted where there was no physical contact, so there was an argument intent was lacking, reports the Los Angeles Times.
Brown declined to comment on his action that is sure to spread HIV like wildfire throughout the population, further burdening California’s public health system.
HIV has been the only communicable disease for which exposure is a felony under California law. The current law, Wiener argued, may convince people not to be tested for HIV, because without a test they cannot be charged with a felony if they expose a partner to the infection.
“We are going to end new HIV infections, and we will do so not by threatening people with state prison time, but rather by getting people to test and providing them access to care,” Wiener said.
Supporters of the bill said women engaging in prostitution are disproportionately targeted with criminal charges, even in cases where the infection is not transmitted. As they say, if you can’t do the time, don’t do the crime, nasty whores.
Republican lawmakers including Sen. Joel Anderson of Alpine voted against the bill, arguing it puts the public at risk.
“I’m of the mind that if you purposefully inflict another with a disease that alters their lifestyle the rest of their life, puts them on a regimen of medications to maintain any kind of normalcy, it should be a felony,” Anderson said during the floor debate. “It’s absolutely crazy to me that we should go light on this.”
Anderson said the answer could be to extend tougher penalties to those who expose others to other infectious diseases.
Meanwhile, the AIDS epidemic risks resurging and spiralling out of control unless billions of extra dollars are pumped into prevention and treatment, experts warned on the eve of a major world conference.
An alarming rate of new infections, coupled with an exploding population of young people in hard-hit countries, meant the world could be steering for “a crisis of epic proportions,” said Mark Dybul, an American AIDS researcher and diplomat.
“Bad things will happen if we don’t have more money,” he told a special event organised a day before some 15,000 delegates attend the opening of the International AIDS Conference in Amsterdam.
The world was “probably at the highest risk ever of losing control of this epidemic because of demographics and because of countries not paying attention the way they once did, or never did in some cases,” warned Dybul.
UNAIDS last week reported a record number of HIV-positive people using life-saving antiretroviral therapy (ARV), and lower rates of deaths and new infections — though not low enough according to campaigners, reports the Daily Mail.
And even this progress risks being overturned.
Speakers warned that donor and domestic funding has dropped significantly, and would likely continue declining.
The US is by far the biggest funder of the global AIDS response.
– Condoms work! –
According to UNAIDS executive director Michel Sidibe, there was a funding gap of almost $7 billion (about six billion euros).
“If we don’t pay now we will pay more and more later,” he told the meeting.
Experts lamented that the successful rollout of life-saving, virus-suppressing drugs may have diverted necessary attention, and cash, away from the need to curb new HIV infections.
ARVs are also increasingly being used, mainly in rich countries, to prevent contracting the virus from sex.
To meet the UN goal of ending AIDS as a public health threat by 2030, infections must be limited to 500,000 per year globally in just two years’ time.
Last year’s 1.8 million new infections showed that “unless we did something completely drastic, we will not get anywhere near” the goal, said Nduku Kilonzo of Kenya’s National AIDS Control Council.
“Condoms work!” she underlined, but only when they are available.
Investment in condom distribution has dropped, and less than half the need was being covered, she said.
“We are far, far, far away from our goal of prevention, not just elimination,” Kilonzo warned. “We have a crisis and it is a prevention crisis.”
James E Windsor, Overpasses News Desk
July 27th, 2018