HIV’s “Patient Zero” was exonerated long ago

The news over the past 24 hours has exclaimed over and over:

HIV’s Patient Zero Exonerated

How scientists proved the wrong man was blamed for bringing HIV to the U.S.

Researchers Clear “Patient Zero” from AIDS Origin Story

H.I.V. Arrived in the U.S. Long Before ‘Patient Zero’

Gaetan Dugas: “patient zero” not source of HIV/AIDS outbreak, study confirms

HIV’s supposed “Patient Zero” in the U.S., Gaetan Dugas, is off the hook! He wasn’t responsible for our outbreak!

This is presented as new information.

gaetan_dugas
Gaetan Dugas, from Wikipedia.

It is not, and I think by focusing on the “exoneration” of Dugas, a young flight attendant and one of the earliest diagnosed cases of AIDS in the U.S., these articles (referencing a new Nature paper) are missing the true story in this publication–that Dugas was really a victim of Shilts and the media, and remains so, no matter how many times the science evidence has cleared his name.

First, the idea that Dugas served to 1) bring HIV to the U.S. and 2) spark the epidemic and infect enough people early on that most of the initial cases could be traced back to him is simply false. Yes, this was the hypothesis based on some of the very early cases of AIDS, and the narrative promoted in Randy Shilts’s best-selling 1987 book, “And the Band Played On.” But based on the epidemiology of first symptomatic AIDS cases, and later our understanding of the virus behind the syndrome, HIV, we quickly understood that one single person in the late 1970s could not have introduced the virus and spread it rapidly enough to lead to the level of infections we were seeing by the early 1980s. Later understanding of the virus’s African origin and its global spread made the idea of Dugas as the epidemic’s originator in America even more impossible.

When we think of Dugas’s role in the epidemiology of HIV, we could possibly classify him as, at worst, a “super-spreader“–and individual who is responsible for a disproportionate amount of disease transmission. Dugas acknowledged sexual contact with hundreds of individuals between 1979 and 1981–but his numbers were similar to other gay men interviewed, averaging 227 per year (range 10-1560). And while Shilts portrayed Dugas as a purposeful villain, actively and knowingly spreading HIV to his sexual partners, that does not jibe with both our scientific knowledge of HIV/AIDS or with the assistance Dugas provided to scientists studying the epidemic. Dugas worked with researchers to identify as many of his partners as he could (~10% of his estimated 750), as the scientific and medical community struggled to figure out whether AIDS stemmed from a sexually-transmitted infection, as several lines of evidence suggested. There’s no evidence Dugas was maliciously infecting others, though that was the reputation he received. Dugas passed away from complications of AIDS in March of 1984–weeks before the discovery of HIV was announced to the general public.

Furthermore, the information in the new publication is not entirely novel. Molecular analyses carried out in part by Michael Worobey, also an author on the new paper, showed almost a decade ago that Dugas could not have been the true “Patient Zero.” The 2007 paper, “The emergence of HIV/AIDS in the Americas and beyond,” had the same conclusions as the new paper: HIV entered the U.S. from the Caribbean, probably Haiti, and was circulating in the U.S. by the late 1960s–when Dugas was only about 16 years old, and long before his career as a flight attendant traveling internationally. So this 2007 molecular analysis should have been the nail in the coffin of the Dugas-as-Patient-Zero ideas.

But apparently we’ve forgotten that paper, or other work that has followed the evolution of HIV over the 20th century.

What is unique about the new publication is that it included a sample from Dugas himself, via a plasma contribution Dugas donated in 1983, and other samples banked since the late 1970s. The new paper demonstrated that Dugas’s sample is not in any way unique, nor is it a “basal” virus–one of the earliest in the country, from which others would diverge. Instead, it was representative of what was already circulating among others infected with HIV at that time. In supplemental information, the authors also demonstrated how notation for Dugas in scientific notes changed from Patient 057, then to Patient O (for “Outside California”) to Patient 0/”Zero” in the published manuscript–which Shilts then named as Dugas and ran with in his narrative.

patient-zero-graphic
Graphic of sexual network of early AIDS cases, from Auerbach et al., Am J Med 1984.

 

The media then extended Shilts’s ideas, further solidifying the assertion that Dugas was the origin of the U.S. epidemic, and in fact that he was outright evil. The supplemental material notes that Shilts didn’t want the focus of the media campaign initially to be about Dugas, but was convinced by his editor, who suggested the Dugas/Patient Zero narrative would result in more attention than the drier critiques of policy and inaction in response to the AIDS epidemic by the Reagan administration.

And the media certainly talked about it. A 1987 edition of U.S. News and World Report included a dubious quote attributed to Dugas: “‘I’ve got gay cancer,’ the man allegedly told bathhouse patrons after having sex with them. ‘I’m going to die, and so are you.’” NPR’s story adds “The New York Post ran a huge headline declaring “The Man Who Gave Us AIDS. Time magazine jumped in with a story called ‘The Appalling Saga Of Patient Zero.’ And 60 Minutes aired a feature on him. ‘Patient Zero. One of the first cases of AIDS. The first person identified as the major transmitter of the disease,’ host Harry Reasoner said.”

This is the real scandal and lingering tragedy of Dugas. His story was used to stoke fear of HIV-infected individuals, and especially gay men, as predators seeking to take others down with them. His story was used in part to justify criminalization of HIV transmission. So while science has exonerated him again and again, will the public–and the media–finally follow?

 

 

 

 

Interview with HIV denier-turned-science-advocate John Strangis

Long-term readers of the blog know of my interest in HIV denialism, especially as it is maintained and spread via the Internet. In my online travels, I recently met John Strangis via this blog post. John has an interesting story to tell regarding his experiences with HIV denialism and subsequently, his turn to patient and science activism. Many thanks to John for sharing it here.

John and family
John with his wife and son.
TS: Can you tell the readers a bit about yourself?
JS: My name is John Strangis. I was born in the United States from Italian parents but lived for fifteen years in Italy when I was brought there at 10 years old after my dad retired; I lived there for 15 years before moving back to the States. I have a technical degree in network engineering and computer tech support and have worked in this field until I was laid off in 2010. After my layoff I developed a love for cooking, self taught myself in culinary arts and discovered I was quite talented so I decided to start my own cooking show on youtube. Along with my youtube channel I run a blog where I post HIV/AIDS information, recipes or anything else I may feel like writing about. I also have a passion for science and medicine, which are topics I love to study on my own as a hobby and also because as an HIV/AIDS activist, I find it important to be knowledgeable about certain issues so I can do a better job informing people about HIV through my activism work which I do through my blog and social media. I am a Social Ambassador for Get Tested Coachella Valley; a region wide public health campaign dedicated to dramatically reducing HIV by making voluntary HIV testing standard and routine medical practice and ensuring linkage to care. I believe it is important for people to see that the H in HIV stands for human and being a heterosexual man living with HIV and a public figure, my work can show others that HIV is a condition that affects us all, can help reduce the stigma and discrimination against people living with HIV and encourage others to get tested and treated.
TS: When were you diagnosed as HIV positive? What was your initial reaction?JS: I was diagnosed with HIV in 2011 after learning that my partner, Jessica was living with HIV. I met her in 2007 and she didn’t disclose her status to me out of stigma and fear of being rejected and although I already knew she was living with HIV because I found her prescriptions for HIV medicines, I decided not to hold it against her because I cared for her deeply. When we started seeing each other she made the mistake of throwing her antiretrovirals away and when I discovered she did so, I strongly urged her to tell me the truth because if she was living with HIV as I believed, the last thing I wanted was for her to fall ill because she was not on treatment. Well, my concern became a reality when after four years, she ended up in the hospital with pneumocystis pneumonia. Fortunately she got better and returned on treatment and I reassured her that if after testing, I was also found to be positive, we would deal with it together and I would never leave her side because of it. It did happen that I tested positive for HIV but my initial reaction wasn’t one of fear; I was aware that HIV today is a manageable chronic condition and just viewed my new status as another bump in the road of life and started researching HIV/AIDS to learn as much as possible for us to be able to live a long and healthy life regardless of living with HIV.

TS: How did you become introduced to HIV denialism? Can you describe your involvement with this movement?

JS: It was during my research on HIV/AIDS that I stumbled upon the denialist information; information which is quite easy to find when doing a search for HIV on google. I was into conspiracy theories at the time and the thought of HIV being a conspiracy was something I found pretty interesting to say the least. I asked questions about the denialist information on official HIV/AIDS websites and was banned for doing so by moderators who told me that I was parroting denialst propaganda. This censorship reinforced my belief that perhaps the denialist information had some truth behind it, without knowing that the reason I was banned was because this information can be and is a danger to public health. I searched for denialst groups to attempt to make contact with these people in order to learn more and this led me to joining the Facebook group “Rethinking AIDS”. Eventually, I decided to become a vocal speaker for the denialists because I believed at the time that their information was genuine and I wanted to do the best I could to spread this information in the hopes of helping other people.

During my time with them I was advised not to speak to certain people from the “orthodox side” because they’re all lying shills and sociopaths or not take seriously scientific information on HIV because according to the denialists it’s all propaganda from the “AIDS establishment”. Once I lifted my confirmation bias and decided to disassociate myself from Rethinking AIDS and denialism in general, it caused a wave of attacks, anger, disbelief and insults with some members even alluding to the fact that I was the leader of Rethinking AIDS at the time. Of course I wasn’t and I always reminded them that I was and independent even if I was supporting their point of view regarding HIV/AIDS. You can say I was very involved with the movement; I spoke on radio shows about denialism, filmed my own youtube videos, wrote my own articles about denialism and attempted to inform every person I could about the denialist information.

TS: You mentioned the notorious HIV denialism documentary “House of Numbers” in your blog post. What did you find so compelling about that movie?

JS: The most famous denialist documentary happens to be “House of Numbers” and denialists recommend the viewing of this film to everyone they speak to because according to them, this documentary and others like it prove their allegations that HIV is a scientific fraud. It does so by attempting to show people how HIV tests are unreliable, HIV has never been isolated, HIV drugs are the cause of peoples’ illness and death, etc. I can honestly say I believed the same until I viewed the youtube series “Debunking the AIDS Denialist Movie House of Numbers” by Myles Power. His series deconstructs “House of Numbers” to show you that the film is nothing more than a biased piece of denialist propaganda. I was aware of Myles’ series when I was still a denialist and never took it seriously because for me and others, his series was nothing other than propaganda from the “AIDS establishment”. Once I disassociated from denialism and lifted my confirmation bias, I decided to give Myles’ videos another watch and this time I could see clearly how deceptive the movie “House of Numbers” is. The film contains interviews with scientists that have been edited in such a way to make people believe these scientists support the idea that HIV is a fraud, when in reality many of their statements were taken out of context and some have even released statements to clarify their real position on HIV/AIDS. People to this day are being misled into believing “House of Numbers” is proof that HIV is a fraud, when in reality it’s a cleverly designed tool of denialist propaganda.

TS: What caused you to modify your stance?

JS: During the last year with the denialists, Jessica and I had a son who was born negative for HIV because my she and my child received the appropriate treatment to avoid vertical transmission. I was still entrenched in denialism during the birth of my son and was not too happy about the doctors wanting to give AZT to my wife and newborn child but decided to do so for two reasons. The main reason was the worry that the authorities would force treatment on my son but the second reason was a thought that crossed my mind: What if I was wrong? We opted for the treatment and hoped for the best and although everything worked out fine for us; the denialists chastised us for our decision. The final blow which led to my disassociation from denialism was when months after our son’s birth, my wife Jessica fell ill with pneumocystis pneumonia again; this time so severe she almost died. Jessica restarted treatment after falling ill the first time in 2011 but only stayed on treatment until we joined the denialists; we both stopped treatment during our time with them because as they preach, we believed the medications were toxic poisons and the real cause of AIDS. Something was definitely not right here and I decided to end my time as and HIV/AIDS denialist. Fortunately Jessica recovered and we are back on treatment but this choice and our disassociation from denialism caused us to be attacked, insulted, unfriended on Facebook by many people I was associated with; something akin to being thrown out of a cult, actually.

TS: What has been the response you’ve gotten from the denialist community? How have you and your wife handled it?

JS: As I previously mentioned, we were attacked, insulted and even my son was brought into the filth they spewed against us. The president of the group “Rethinking AIDS”, David Crowe, accused me of selling my soul to the devil, many others continued to harass me and even told me that our decision to get back on treatment will result in the death of my whole family. My wife and I have pretty thick skins and while she ignores them and is happy she is doing better now, I use my knowledge to help other people avoid the same trap we fell into in the hopes that perhaps I can do some real good this time and avoid people’s suffering because they were fed and believed incorrect medical information. The best example I can make of how we were treated by the denialist community after our disassociation would be how a member of Scientology is treated once he or she decides to abandon the church. To the denialists we are nothing more than human garbage. I was called a shill and a sellout, and they accuse me of leading people to the death camps because today I promote HIV/AIDS awareness instead of pseudoscientific nonsense. The denialists in my eyes are a cult; too bad I did not see this before becoming entrenched into their dogma and becoming a voice for their agenda.

TS: How do you feel others can avoid being miseld (potentially dangerously so) by the denial movement?

JS: In the past, censorship of denialist information was the norm; pretend it doesn’t exist and hope nobody will notice. I believe that people should be informed about the dangers of eschewing necessary treatment for HIV and what can possibly happen to them if they do. I have people writing to me daily asking for help or wanting to hear my story because they got involved in denialism and are falling ill but don’t know what to do. Although I cannot and do not offer medical advice, I share my story in the hopes that they make the best choice for themselves. It’s great to also hear one of these same people write to me again down the road to thank me because their health has improved after returning on or starting treatment. Articles such as this one and many others exposing the denialist agenda are a great help and I will continue to do my part to make sure people understand the risks they are taking when getting involved with HIV/AIDS denialism. Giving people the correct information regarding HIV/AIDS, how today it is no longer a death sentence and that on treatment they should expect to live a long and healthy life comparable to a person not living with HIV is also very helpful. For now me and a few others are the only voices speaking against denialism but there should be more. In some countries it’s illegal to disseminate incorrect medical information and I believe such a law could prove to be of some benefit in this country as well. The article entitled “Can You Inoculate Against Science Denial?” is a great read and explains very well what we are facing today and how to approach this issue.

TS: What message would you pass on to others who are newly diagnosed?

JS: If you’re newly diagnosed, the treatments today can keep you healthy and living a long life comparable to a person not living with HIV and there are many people and organizations that can offer you support; you are not alone. Remember, HIV doesn’t define you, you define HIV. Being newly diagnosed is a life changing experience, but it doesn’t have to be a bad experience. By getting tested and getting into treatment, you are taking control of your health. Become informed as much as you can about HIV. Ask your doctor questions, research, reach out to support groups and if you happen to stumble upon the denialist information, make sure you know what you’re possibly getting yourself into before jumping on the bandwagon. If anyone newly diagnosed is reading this and would like to contact me for information or support, feel free to reach out.

HIV denial: alive and well in 2014 [UPDATED]

Everything old is new again. For years on this blog, I wrote about HIV denial and the few fringe scientists and journalists who espoused it. I attracted a host of trolls, some of whom repeatedly attacked my credibility, my appearance, even showed up at my academic office. One of the most prolific of these was Henry Bauer, who posts long-debunked ideas on HIV/AIDS (and the Loch Ness Monster to boot).

That was, oh, 2007-ish and prior. In that same year Steven Novella and I co-authored an article on HIV denial for PLoS Medicine. In 2008, a leader of the denial movement, Christine Maggiore of “Alive and Well AIDS alternatives,” died of AIDS. In 2009, books were released from Seth Kalichman  (Denying AIDS)  and Michael Specter (Denialism), both further outlining the reasons why HIV denial is so, so, so incredibly flawed and dangerous. Seth still runs his blog, and HIV denial hasn’t gone away, but it’s lost some prominence in recent years–at least in the US.

For whatever reason, this week has been a hotbed of it.

First, MD/blogger Kelly Brogan had a post in support of HIV denial , specifically addressing pregnant women (currently taken down but the internet never forgets).

Now even worse, Frontiers in Public Health, an actual, peer-reviewed journal, has published a paper that is straight-out, unvarnished, HIV denial. Full stop. This journal is part of the “Frontiers in” series, that many readers will probably be familiar with. FPH claims that

Each Frontiers article is a landmark of the highest quality, thanks to genuinely collaborative interactions between authors and review editors, who include some of the world’s best academicians. Frontiers is well aware of the potential impact of published research both on future research and on society and, hence, does not support superficial review, light review or no-review publishing models. Research must be certified by peers before entering a stream of knowledge that may eventually reach the public – and shape society. Therefore, Frontiers only applies the most rigorous and unbiased reviews, established in the high standards of the Frontiers Review System. Furthermore, only the top certified research, evaluated through the democratic Frontiers Evaluation System, is disseminated to increasingly wider communities as it gradually climbs the tiers of the Frontiers Tiering System from specialized expert readership towards public understanding.

Except, no way in hell is that accurate after the publication of this manuscript: “Questioning the HIV-AIDS hypothesis: 30 years of dissent,” by a professor at Texas A&M University named Patricia Goodson. Goodson’s qualifications appear to be in health education, including sexual health (and many publications related to abstinence-only education and to abortion), but nowhere do I see any publications or training relevant to epidemiology or virology.

The paper itself consists entirely of the old claims that have been debunked time and time and time and time again, using tactics we defined in our paper: quote-mining, cherry-picking evidence, moving goalposts, citing prominent deniers and denial groups, and more. There is nothing of value here, and the only real nod she gives to orthodox opinions on HIV are to cite Kalichman’s book ever-so-briefly and dismissively (characterizing it as “a harsh critique of unorthodox views and of Duesberg in particular”). 

And who is behind the curtain? Well, for one, Henry Bauer, who appears immediately in the comments of the paper, pimping his list of HIV denial resources. Goodson comments (click to embiggen):

Goodman and Bauer

So how in the world did this paper make it into a peer-reviewed journal with the stamp of approval of the Frontiers line and backing of Nature Publishing Group?  (EDITED via comments: Grace Baynes of NPG notes that Frontiers journals are editorially independent from NPG; see my response below). The two reviewers, Preeti Negandhi and Lalit Raghunath Sankhe are also apparently both members of the FPH editorial board, despite almost no academic record. Neither has experience in HIV/AIDS , but the latter appears to be the editor,  Sanjay P Zodpey‘s go-to reviewer, while the former only has one publication listed on the FPH page, co-authored with Zodpey on public health capacity development in India. No publications are listed on Sankhe’s page, but there was one I could find which may possibly be associated with this name. Other than that, zero record in PubMed.

Why were these people, who clearly have as little background in this area as Goodson does, chosen as reviewers? This is, at the best, a pathetic excuse for peer review and editing, and completely unprofessional and unacceptable. Did Zodpey, who does appear to have some background in HIV, even read the article before passing it along to two unqualified reviewers? This type of review makes a mockery of the entire system and makes us all look bad.

Even worse, papers like this are clearly dangerous. I wrote not even a week ago about the deadly distrust so many have in our medical system, and cited HIV denial as an example. South African policies regarding HIV (and the denial that the virus was behind AIDS) led to an estimated 330,000 premature deaths from AIDS, and 35,000 infants born with HIV infections that could have been prevented in that country alone.  This is what Goodson and Bauer (among others) are supporting. Frontiers and Nature, do you really want to be a part of this as well?

(Tip o’ the hat to Kenneth Witwer and Brian Foley for bringing this to my attention.)

UPDATED 9/26 The Frontiers Editorial Office has posted a Statement of Concern on their site regarding the paper:

Statement of Concern: The article “Questioning the HIV-AIDS hypothesis: 30 years of dissent” (Goodson 2014), was accepted for publication on the 7th September 2014. In its duty to publish responsibly, and in light of numerous complaints received about the paper, Frontiers has launched an investigation, the outcome of which will be made public once all adequate procedures have been completed. September 26, 2016. Frontiers Editorial Office, Lausanne, Switzerland.

 

Deadly distrust

Gregg Mitman’s article in the September 17th New England Journal of Medicine, “Ebola in a Stew of Fear,” is unfortunately all too prescient. Dr. Mitman highlighted “the ecology of fear” in Western Africa. Fear is present on both the part of Westerners (scared of Africa’s yellow fever, malaria, Ebola, its mere “different-ness”), and by native Africans (of whites’ history of colonization and slavery, of medical exploitation dating back well over a century). Fear of each other.

This history of fear, the cultural legacy of decades of mistrust of both Western people and their medical science, played a role in the murders of 8 people working on the Ebola outbreak in Guinea–journalists, medical officers, local administrators, and a preacher who were just trying to educate locals about the virus. The hostile crowd first threw stones at the team, and ended in their brutal deaths. The steps in-between have not been reported.

This is the extreme end of the science and medical denial continuum. We can scoff in America and attribute such horrors to the “brutal, savage Africans,” who cut their daughters and rape virgins to cure AIDS, as I’ve unfortunately already seen in some Twitter comments–some of our notions of “them” not so dissimilar from American colonists of centuries past regarding the slaves they once owned.

We can accept this scape-goating and ignore the West’s own modern-day culpability, with our fake vaccination campaigns that have left others dead in the aftermath; with our movies and popular culture depicting Africans as the West’s guinea pigs, and our shady pharmaceutical dealings that make that characterization all too believable.

No, it isn’t always a battle of Africans against Westerners. In South Africa, former President Thabo Mbeki was deceived by false claims about the relationship between HIV and AIDS that he had read on the internet, suggesting that HIV was not the cause of AIDS, and that  Western science should be distrusted in favor of traditional herbal remedies recommended by his health minister, such as garlic and beetroot. Because of his suspension of Western medical treatments, an estimated 330,000 South Africans died prematurely from HIV/AIDS between 2000 and 2005 , and at least 35,000 babies were born with HIV infections that could have been prevented.

Denialism kills. Distrust kills. Fear kills.

Here in the U.S., Natural News, a site run by the self-dubbed “Health Ranger,” Mike Adams, ran a piece this past summer suggesting that journalists and scientists who defended genetically-modified organisms (GMOs) were similar to Nazis, accelerating “heinous crimes being committed against humanity” and collaborating with an “with an anti-human regime,” and that such individuals should be named as such for future crimes:

“Just as history needed to record the names and deeds of Nazi war criminals, so too must all those collaborators who are promoting the death and destruction caused by GMOs be named for the historical record. The true extent of their collaboration with an anti-human regime will all become readily apparent once the GMO delusion collapses and mass global starvation becomes an inescapable reality.

I’m hoping someone will create a website listing all the publishers, scientists and journalists who are now Monsanto propaganda collaborators. I have no doubt such a website would be wildly popular and receive a huge influx of visitors, and it would help preserve the historical record of exactly which people contributed to the mass starvation and death which will inevitably be unleashed by GMO agriculture (which is already causing mass suicides in India and crop failures worldwide).”

Adams is similarly anti-vaccine, and currently is featuring on his website “11 horrible truths about Ebola the government doesn’t want you to know.” These “truths” include suggesting that infected individuals should avoid hospitals, and that citizens everywhere should prepare for the inevitable quarantine at gunpoint.

The worst part of Adams’ misinformation of this type is that it doesn’t stay within the borders of the U.S.–misinformation on Ebola epidemiology and quack cures like those Adams promotes are also being spread in African nations via Facebook pages and other types of social media

Denialism kills. Distrust kills. Fear kills.

Because of distrust of Western medicine, a recent article noted that parts of Africa have better vaccination rates than many wealthy neighborhoods in Los Angeles–and as a result, 10 babies died in a 2010 outbreak of whooping cough in California.

The deaths of the workers in Guinea show this fear and denial writ large; the purposeful killing of those only wanting to help their local and global neighbors in the face of a terrible epidemic. Those murdered are the latest victims of the most malignant form of distrust. They will not be the last.

Student guest post: Are parasites causing a rise in the global HIV epidemic?

Student guest post by Carrie Ellsworth

During the summer of 2010 I spent two months in Ghana studying a parasite called schistosomiasis. We worked in a small town called Adasawase to determine prevalence and treat the schoolchildren who were infected. We were told that schistosomiasis was not a major health concern for the people in the town because they were often faced with other diseases that had more immediate and severe health consequences than a parasitic infection. It became apparent that if we wanted the people of this small town to take this health threat seriously, we needed to stress the long term health sequelae that could arise due to schistosome infections.

Carrie picture 1

(Personal photo taken in Ghana in 2010)

Our research group decided to implement an educational portion to our schistosomiasis control program. Through a Knowledge Attitudes and Practices survey, we found that most schoolchildren in the town reported learning about health from their teachers in school. We held a meeting with all teachers and administrators from Adasawase to educate them on the transmission, symptoms, and long term implications of schistosomiasis infections. When the possibility of greater transmission of HIV to individuals with schistosomal infections came up in discussion, we suddenly had everyone’s complete attention. You could have heard a pin drop on the cement floor of the school room.

Recently, the BBC reported that over 25% of schoolgirls between the ages of 10 and 14 in South Africa are infected with HIV. The World Health Organization has shown that HIV prevalence is much higher in females living in urban areas than in any other demographic group. More than 2/3 of the world’s population living with HIV/AIDS lives in Sub-Saharan Africa. Many efforts have been made to decrease the prevalence of HIV in Africa but few people have looked at the possibility of a parasitic infection possibly contributing to the transmission of HIV.

Carrie picture 2

(http://www.who.int/gho/urban_health/outcomes/hiv_prevalence/en/index.html)

Schistosomiasis haematobium is a species of waterborne parasite that specifically affects the urogenital system of infected individuals. When people with S. haematobium urinate in stagnant water, they deposit schistosome eggs. The eggs develop into larvae which then enter a freshwater snail to continue its life cycle and mature. It leaves the snail and matures into its infective stage while in the water. The mature larval form of the parasite burrows through the skin of an individual who has contact with contaminated water. Once inside the body, the mature larva develops into an adult worm and then travels to the blood vessels surrounding the bladder. The male and female will mate to produce eggs which penetrate through the bladder wall and are passed in the urine to continue the cycle.

The treatment for a schistosomiasis infection is an inexpensive anti-helminthic medication called Praziquantel. Common signs of a S. haematobium infection are bloody and cloudy urine. Damage to the bladder wall is inevitable and if the infection becomes chronic, damage to the kidneys can also ensue. Chronic genital sores can develop in females with S. haematobium infections when the schistosome eggs are deposited in the uterus, vulva, cervix, and vagina. These lesions are believed to put the females with S. haematobium infections at a greater risk of contracting HIV. A study conducted in Zimbabwe showed that women ages 20-49, who had genital lesions due to a urogenital schistosomiasis infection, had a 3-fold higher risk of having HIV than women without a schistosomal infection.

There are 207 million cases of Schistosomiasis worldwide, and 112 million of those cases are urogenital Schistosomiasis found in Sub-Saharan Africa. This creates a significant overlap between areas of Africa that are endemic to HIV/AIDS and Schistosomiasis. This has caused many scientists to question whether a greater effort to control S. haematobium infections would be an effective method of decreasing the prevalence and transmission of HIV/AIDS in Africa.

Carrie picture 3

(http://blogs.plos.org/speakingofmedicine/2013/05/06/female-genital-schistosomiasis-fgs-sub-saharan-africas-secret-scourge-of-girls-and-women/)

There is a Schistosomiasis Control Initiative (SCI) based out of London which is attempting to implement schistosome control methods in areas that are endemic. A study done in Burkina Faso showed that a single mass treatment with Praziquantel was shown to decrease the prevalence of S. haematobium by 84% in girls and 78% overall for up to 2 years. The WHO has a strategy of mass drug administration (MDA) in which school aged children in areas that have a greater than 10% prevalence of schistosomiasis would receive Praziquantel on a biannual basis, and areas that have greater than 50% prevalence would receive treatment on an annual basis. Treatment with Praziquantel results in a parasitological cure but will not heal genital lesions that have already developed from a S. haematobium infection. For this reason, prophylactic treatment starting at a young age is crucial in using this method as a means to decrease HIV prevalence.
It only costs about 32 cents to treat one child with Praziquantel. In most developing countries Praziquantel is distributed through bulk sales to the government. From there, the government dispenses its allotted Praziquantel out to different programs. The organizations that supply developing countries with Praziquantel include UNICEF and the World Health Organization among many other international organizations. Data has shown that a schistosomiasis infections increase susceptibility to HIV, elevate viral replication, exacerbate immunosuppression and increase transmission of HIV. Due to these findings, greater emphasis on schistosomiasis control is being pursued as a means of decreasing the ever growing HIV/AIDS prevalence in Africa. Widespread distribution of Praziquantel to schoolchildren in countries endemic to both schistosomiasis and HIV/AIDS could potentially prevent 120,000 new cases of HIV/AIDS in the next decade.

If treatment with Praziquantel for one child costs $0.32, then treating 70 million children would cost $22 million for one year. If a 10 year plan was implemented that treated every one of those 70 million children biannually, that would cost approximately $112 million. Compare that with the $18.8 billion that has been proposed to be spent over the next 5 years by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The cost of treating 70 million children for schistosomiasis over a 10 year span is dwarfed by the projected costs of the PEPFAR and could potentially make a significant change in the rising trend of HIV infections in Africa.
All of the research points towards mass treatment with Praziquantel as being the most cost effective and successful method of decreasing the number of schistosomiasis infections and HIV/AIDS transmission. The cooperation between HIV and schistosomiasis control programs is critical in ensuring the success of such a program. Combatting two of Africa’s top health concerns with one simple low cost medication would do wonders for lowering the morbidity and mortality rates of many African countries.

References:
“HIV and AIDS Statistics: Worldwide.” Statistics: Worldwide. AmfAR, Nov. 2012. Web. 10 June 2013. <http://www.amfar.org/about_hiv_and_aids/facts_and_stats/statistics__worldwide/>.
Hotez PJ, Fenwick A (2009) Schistosomiasis in Africa: An Emerging Tragedy in Our New Global Health Decade. PLoS Negl Trop Dis 3(9): e485. doi:10.1371/journal.pntd.0000485
Hotez, Peter J., Alan Fenwick, and Eyrun F. Kjetland. “Africa’s 32 Cents Solution for HIV/AIDS.” PLoS Neglected Tropical Diseases 3.5 (2009): E430. Print.
“International Strategies for Tropical Disease Treatments – Experiences with Praziquantel – EDM Research Series No. 026: Chapter 5: The International Supply of Praziquantel*: Global Distribution of Praziquantel.”

International Strategies for Tropical Disease Treatments – Experiences with Praziquantel – EDM Research Series No. 026: Chapter 5: The International Supply of Praziquantel*: Global Distribution of Praziquantel. World Health Organization, 2013. Web. 10 June 2013.
Kosinski, Karen C., Kwabena M. Bosompem, Miguel J. Stadecker, Anjuli D. Wagner, Jeanine Plummer, John L. Durant, and David M. Gute. “Diagnostic Accuracy of Urine Filtration and Dipstick Tests for Schistosoma Haematobium Infection in a Lightly Infected Population of Ghanaian Schoolchildren.” Acta Tropica 118.2 (2011): 123-27. Print.
“Schistosomiasis.” World Health Organization. Web. 10 June 2013. <http://www.who.int/mediacentre/factsheets/fs115/en/>.
“Schistosomiasis: Epidemiological Situation.” World Health Organization. N.p., n.d. Web. 10 June 2013. <http://www.who.int/schistosomiasis/epidemiology/en/>.
Secor, Evan W. “The Effects of Schistosomiasis on HIV/AIDS Infection, Progression, and Transmission.” Current Opinions on HIV and AIDS 7.3 (2012): 254-59. Print.
Simon, Gregory. “Combined Schistosomiasis and HIV Control Programs: Saving Lives AND Money”. End the Neglect. N.p., 7 May 2013. Web. 11 June 2013. <http://endtheneglect.org/2013/05/combined-schistosomiasis-and-hiv-control-programs-saving-lives-and-money/>.
“South Africa: ‘Over 25% of Schoolgirls HIV Positive'” BBC News. BBC, 14 Mar. 2013. Web. 10 June 2013. <http://www.bbc.co.uk/news/world-africa-21783076>.
Temple, Bliss. Schistosoma Haematobium (blood Flukes). Schistosomiasis Haematobium (blood Flukes). Stanford University, May 2004. Web. 10 June 2013. <http://www.stanford.edu/class/humbio103/ParaSites2004/Schisto/website.html>.

Student guest post: Challenges and Progresses in HIV Vaccine Research

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. Third one this round is by Jack Walsh. 

The Human Immunodeficiency Virus (HIV) infection is one of the most significant global health challenges of this 21st century. Since the isolation of the virus in 1983, it has infected 70 million people among whom 35 million have died of Acquired Immunodeficiency Syndrome (AIDS).1 Although important progresses have been made in slowing down the pandemic and reducing the morbidity and mortality related to HIV/AIDS with the highly active antiretroviral therapy (HAART) drugs, there are still difficulties in stopping the dissemination of the infection. It is estimated that for every person gaining access to HART, there are two new others infected by the virus.2 An effective and safe vaccine is therefore needed to prevent HIV from spreading, but the development of the vaccine has been proven to be an enormous scientific challenge.

HIV presents particularities that make it very difficult for researchers to find a vaccine. It is a lentivirus from the Retroviridae family, slowly progressive using an enzyme (called reverse transcriptase) for the transformation of its genome or genetic material (RNA in this case) into a new one (proviral DNA) integrated in that of the human host using another enzyme known as integrase. One of the most fascinating characteristics of the virus is its genetic variability in both an infected individual and geographically. In a same person, new mutations can be introduced in almost every new copy, creating up to millions of new particles every day. One antibody could then neutralize one virion, but not another.3 Additionally, super-infection in an individual already HIV infected results in new recombinants increasing further viral genetic diversity. The virus also presents two different types, HIV-1 worldwide and HIV-2 confined to West Africa. HIV-1 is further subdivided into subtypes or clades differently distributed on the globe and further diversified within each clade. Moreover, by integrating proviral DNA in the genome of memory cells of the immune system (CD4+ T cells) the HIV can escape the immune surveillance. To complicate the development of an effective vaccine, the virus envelope is able to hide receptor site to antibody that could potentially inhibit its effect (neutralizing antibodies). This explained the inefficiency of antibodies generated by vaccines targeting the glycoprotein 120 (gp120) located on the surface of virus developed in early vaccine trials.4

However, despite these challenges, encouraging progresses in the development of an effective HIV vaccine have been made. The first HIV vaccine trial was opened at the National Institutes of Health (NIH) Clinical Center in 1987, including 138 healthy volunteers. Other large scale trials included participants from North America and The Netherlands (1998), then Africa and Asia (1999).5 Three main approaches have been used in the development of an HIV vaccine: 1) the induction of neutralizing antibodies against HIV using the virus envelope proteins (gp120 or 140), 2) the use of viral vectors to stimulate responses form killer cells (CD8 T-cells or T cell that would recognize antigens on virus surface of the virus-infected cell, binds to it, and kill it), and 3) the optimization of cellular immunity (activation of killer cells) and humoral immunity (production of antibody) with prime-boosts (administration of one type of vaccine, such as a live-vector vaccine, followed by or together with a second type of vaccine, usually a recombinant).6 Also, to cope with the genetic variability of the virus, multiple strategies are explored, such as mixing envelope immunogens from several HIV subtypes or clades. Unfortunately, most of the tested vaccine models did not significantly reduce HIV infection in participants, except an envelope-based subunits’ vaccine tested in Thailand which showed significant decline by about 30% in HIV infection in 2009.7 Though modest, the results clearly show that HIV/AIDS is a vaccine preventable disease. More recently in 2012, a Spanish study showed promising results in the development of a therapeutic HIV vaccine effective in reducing the viral load by 90% after 12 weeks of therapy, awkwardly the vaccine lost effectiveness within a year.8 Just a few days ago, the Duke Human Vaccine Institute team published an important study, in which it has been able for the first time to map the co-evolutions of antibodies and virus in an infected individual, whose immune system launched a broad attack against the pathogen, using new technologies. They also identified the viral surface glycoprotein, which initiated the neutralizing antibody development.9

Despite two decades of disappointing results on HIV vaccine research, we now have started to see encouraging advances. For the first time a candidate vaccine was successful in significantly reducing the HIV infection. Furthermore, an important progress has been made very recently in identifying neutralizing antibodies initialization and mapping. The study provides crucial insights for the development of a vaccine that could mimic the actual antibody development and elicit non-strain specific antibodies. Progress towards finding an effective vaccine is slow, but we can optimistically say that the future is promising.

 

References

[1] World Health Organization (WHO), Global Health Observatory (GHO). HIV/AIDS, Global situation and trends. 2012. http://www.who.int/gho/hiv/en/

2 Letvin, Norman L. “Progress and obstacles in the development of an AIDS vaccine.” Nature Reviews Immunology 6.12 (2006): 930-939.

3Letvin NL. Progress Toward an HIV Vaccine. Annu. Rev. Med. 2005. 56:213–23

4Marc GP, OsmanovSK, Kieny MP. “A review of vaccine research and development: the human immunodeficiency virus (HIV).” Vaccine 24.19 (2006): 4062-4081.

5 National Institute of Allergy and Infectious Diseases (NIAID). History of HIV Vaccine Research. 2012. http://www.niaid.nih.gov/topics/hivaids/research/vaccines/Pages/history.aspx

6 Ross, Anna Laura, et al. “Progress towards development of an HIV vaccine: report of the AIDS Vaccine 2009 Conference.” The Lancet infectious diseases 10.5 (2010): 305-316.

7 Rerks-Ngarm, Supachai, et al. “Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand.” New England Journal of Medicine 361.23 (2009): 2209-2220.

8 García, Felipe, et al. “A Dendritic Cell–Based Vaccine Elicits T Cell Responses Associated with Control of HIV-1 Replication.” Science translational medicine 5.166 (2013): 166ra2-166ra2.

9 Liao HX et al. Co-evolution of a broadly neutralizing HIV-1 antibody and founder virus. Nature 2013. Epub April 3, 2013

HIV In-Home Testing Kits: Increased Awareness or Increased Problems?

Fifth of five student guest posts by Jonathan Yuska

The saying, “The more you know, the more you can control,” is no more meaningful than when used in the context of HIV detection and prevention. Public health advocates endlessly stress the need for knowing one’s status; and one would assume that any way in which the most amount of people can be tested would be beneficial for the population1. The Food and Drug Administration shared this same idea when they overwhelmingly approved the first ever over-the-counter (OTC) HIV testing kit in 20052; which in theory, sounds like a promising way to reduce the possible 350,000 HIV cases that remain undiagnosed in this country3. Though, some medical staff are still weary of this type of diagnostic method for reasons such that it breaks the linkage between the patient and long-term care. The debate on whether HIV testing should be—shall we say—left only to the professionals or put in the hands of everyday citizens is only just beginning; though, here are some points you may want to consider when making your own opinion on HIV home testing.

The OraQuick ADVANCE is one example of an in-home testing kit that provides the user with an accurate (sensitivity of 99.3% and specificity of 99.8%) and rapid means of HIV detection with nearly no invasiveness. In just 20 minutes and a swab of the mouth, individuals who may have been living their entire life unaware they are HIV positive, now can take that knowledge as empowerment to manage their health safely and finally receive the appropriate care they may desperately have needed. Supporters of in-home kits believe it offers a choice of what to do with the knowledge of being diagnosed and dismisses possible stigmatizations associated with being tested since testing can be done in the privacy of one’s own home. Proponents also feel that HIV home testing may become the new norm before engaging in intimacy and suggest testing kits come in boxes of two so partners can test each other4. The OTC HIV testing kits are hoped to slow down the more than 40,000 new infections3 that occur every year in the United States; though, some that believe kits such as OraQuick will make little difference in reducing the HIV infection crisis in the populations that need it most.

The HIV home testing kit is hoped to attract those at highest risk including young, low-income and education, non-white males who neither frequent medical care facilities nor are tested regularly on their HIV status5. Surveys conducted by the National Center for Health Statistics have shown that 79% of persons in these types of populations would indeed use home HIV tests if available; though, when participants in the survey were told the price of testing kits was $40, the approval rate of the kits dropped to 40%2. This raises some speculation on whether OTC kits will actually access these sorts of populations without first lowering the price to purchase them.

Rather than accessing those at highest risk, some naysayers anticipate the tests will predominantly appeal only to those “worry well” or hypochondriac individuals who continually test negative or new couples that want to verify their HIV statuses before sexual intimacy begins. Though, what one does with the knowledge of having tested negative for HIV is still under question. It may be seen that negative results actually promotes more risky sexual behaviors—since they were able to “get away” with it in the past—such as having intercourse without protection. This sort of risky behavior may expose the individual to a whole host of other sexually transmitted diseases2.

Issues with the proper usage of kits may also pose a problem in accurately diagnosing those who have been recently infected with HIV which could lead to false-negative results. Individuals participating in unsafe practices may be unaware of the 8-week “window period” needed for in-home tests to detect HIV antibodies (human antibody component is needed to determine HIV status in at-home tests [RNA tests commonly used by clinics can detect HIV within 9 to 11 days post infection]) and unwittingly spread their infection to others6.

False-positive results from in-home tests may also cause a great deal of damage to the validity of proven HIV detection methods as well as the likelihood of individuals to repeat HIV testing after receiving highly upsetting untrue news. False positive outcomes from tests are most common in populations with a low occurrence of disease in the first place—like in HIV—where the occurrence of unknown cases is roughly 0.2%. The ability to perfectly detect such a small percentage of people infected even with a test that is highly sensitive and specific is extremely unlikely and the predictive value of the test will be noticeably low2.

Lastly and most obviously is the disconnect from care that occurs from in-home diagnostic kits. Public testing focuses on linking HIV-positive patients with counseling and treatment; though, when this diagnosis is done in private, a person’s anxiety may force them to exile where they never seek treatment and may even contemplate suicide1. It is important to note that diagnosing patients is only half of the battle, linking them to the appropriate care is the other half—something home testing inherently does not do.

“The more you know, the more you can control” is a saying that is at the heart of reducing the amount of HIV transmissions person-to-person by knowing one’s status. HIV home testing kits such as OraQuick sounds like a promising way to reduce the number of transmissions since they are quick and convenient for the user, but whether these tests will actually reach those individuals who are at greatest risk is doubtful. At home kits may also promote risky behaviors, increase the numbers of false-positives and –negatives, and deteriorate the linkage to care that is vital to those with new diagnoses.

Will in-home HIV testing kits be the assistance needed in decreasing the HIV transmission concern—some professionals are questionable. Now after reviewing the facts on HIV home testing, what is your stance on the subject?

Sources:

1. Chesney, Margaret A., and Ashley W. Smith. “Critical Delays in HIV Testing and

Care.” American Behavioral Scientist. Apr. 1999. 17 Feb. 2013             <http://abs.sagepub.com/content/42/7/1162.short>.

2. Walensky, Rochelle P., and David Paltiel. “Rapid HIV Testing at Home: Does It Solve

a Problem or Create One?” Annals of Internal Medicine (2006): 459-562.

3. Fleming, P. L. “HIV Prevalence in the United States, 2000.” Feb. 2002. 18 Feb. 2013

<http://stdpreventiontraining.jhmi.edu/docs/Fleming%20et%20al_HIVPrev_Seattle_CROI_2002.pdf>.

4. McNeil, Donald G. “Another Use for Rapid Home H.I.V. Test: Screening Sexual

Partners.” The New York Times. 5 Oct. 2012. 18 Feb. 2013 <file:///Users/ska020/Desktop/Another%20Use%20for%20Home%20H.I.V.%20Test%20-%20Screening%20Partners%20-%20NYTimes.com.webarchive>.

5. Phillips, Kathryn A. “Potential Use of Home HIV Testing.” The New England Journal

of Medicine. 11 May 1995. 18 Feb. 2013 <http://www.nejm.org/doi/full/10.1056/NEJM199505113321918>.

6. “Possible Exposure to HIV?” How long it takes to test HIV positive after infection.

Stop AIDS Project. 18 Feb. 2013 <http://stopaids.org/resources/possible-exposure-hiv/time-it-takes-test-positive>.

The impact of HIV on Drug-Resistant Tuberculosis

Second of five student guest posts by Nai-Chung N. Chang

Tuberculosis (TB) is a major disease burden in many areas of the world. As such, it was declared a global public health emergency in 1993 by the World Health Organization (WHO). It is a bacterial disease that is transmitted through the air when an infected individual coughs, sneezes, speaks, or sings. However, not all individuals who contract the disease will display symptoms. This separates the infected into two categories, latent and active. Latent individuals are non-infectious and will not transmit the disease, whereas active individuals are able to transmit the disease.

TB is a significant concern in patients diagnosed with HIV, since individuals diagnosed with HIV and latent forms of TB infection is more likely to develop the disease, then the HIV negative individuals. In addition, in people living with HIV, TB is one of the leading causes of death. (CDC, 2012) The fact that latent forms of the disease are capable of becoming fully active forms given the right stimulus represents a high risk to individuals living in poor conditions, which is widely present in developing nations. It is of even greater concern to individuals who have immune system diseases, such as HIV. Individuals with latent TB infection depend on robust immune system responses to prevent the infection from going into active form. HIV and similar diseases targets and weakens immune systems so that the response to infections becomes weaker, providing increased risk of TB infections and the activation of latent forms.

TB is a major concern not only because of its status as a global epidemic. While there are many forms of prevention and treatment for the disease, such as antibiotics and vaccine, these treatments are not overly effective in combating and controlling the spread of the disease. TB is widespread and has a high chance of becoming resistant to any treatment that it is exposed to, especially antibiotics and other chemotherapeutic drugs such as isoniazid. Several of these strains already exist and each has varying levels of resistance, including Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR). MDR is a strain that is resistant to two of the most often used and potent TB drugs, isoniazid and rifampin; whereas XDR is MDR strains that have developed resistance to any fluoroquinolone and at least one of three second-line drugs such as kanamycin or capreomycin. Also, the vaccine that has been developed for preventing TB is not overly protective, and sometimes fails to protect against infection. (CDC, 2012) The vaccine is not designed to prevent the infection of TB; instead, it is aimed towards boosting and speeding up the immune system response to any new infection so that the infected individual remains in latent forms. (Russell, et al., 2010)

The increasing trends in the resistance of TB to various treatments is a serious concern as it have major impacts in controlling the spread of the disease in many regions. This condition worsens with MDR and XDR TB. With regular, normal strains of TB, latent and early infections could be combated and controlled by a successful chemotherapeutic treatment even in patients with immune system diseases. However, with MDR and XDR TB, the strains are able to fully develop in an individual with weakened immune system, as evident in areas where incidence of TB and HIV is high, such as South Africa. (O’Donnell, et al., 2013) For cases with MDR and XDR strains, the weakened immune systems are not potent enough to prevent infections or keep them in latent form. Additionally, the active forms of these strains are resistant to common, and in some cases, advanced treatments.

With the increasing development of drug-resistant TB, the most effective way to combat TB is not only through vaccines and treatments. Instead, strict public health policy is needed to properly maintain control and combat the spread of TB. With a well-structured public health system, we can ensure that the long treatment of TB is complete, since most of the increase in the resistance to treatment often results from issues during treatment. Events such as patient non-compliance to the treatment and inadequate health-care supervision can all result in the development of new strains of the bacteria that have developed resistance to the treatments that was used. (Russell, et al., 2010) Also, a well-structured public health system can maintain better supply and quality of drugs throughout the treatment process, as well as the prevention and detection of possible new drug resistant strains. More importantly, it can maintain better surveillance and ensure patient compliance during the treatment process, which would help in reducing the development of drug resistant strains. The surveillance systems can also target comorbid diseases such as HIV to reduce risk factors for activating latent forms of the disease in patients with HIV and similar diseases.

References:
CDC, 2012. Tuberculosis (TB). [Online]
Available at: http://www.cdc.gov/tb/topic/basics/default.htm
[Accessed 13 2 2013].
O’Donnell, M. R. et al., 2013. Treatment Outcomes for Extensively Drug-Resistant Tuberculosis and HIV Co-infection. Emerging Infectious Disease [Internet], 19(3).
Russell, D. G., Barry 3rd, C. E. & Flynn, J. L., 2010. Tuberculosis: What We Don’t Know Can, and Does, Hurt Us. Science, 328(5980), pp. 852-856.

“Spillover” by David Quammen

Regular readers don’t need to be told that I’m a bit obsessed with zoonotic disease. It’s what I study, and it’s a big part of what I teach. I run a Center devoted to the investigation of emerging diseases, and the vast majority of all emerging diseases are zoonotic. I have an ongoing series of posts collecting my writings on emerging diseases, and far too many papers in electronic or paper format in my office to count. Why the fascination? Zoonotic diseases have been responsible for many of mankind’s great plagues–the Black Death, the 1918 “Spanish” flu pandemic, or more recently, HIV/AIDS. So you can imagine my delight when I read about Spillover, a new book by David Quammen on zoonotic diseases.

I’ve previously highlighted some of Quammen’s work on this site. That link goes to a 2007 story he wrote for National Geographic on “infectious animals,” which really serves as a preview to “Spillover,” introducing some of the concepts and stories that Quammen elaborates on in the book.

“Spillover” is wide-ranging, tackling a number of different infectious agents, including viruses like Nipah, Hendra, and Ebola; bacteria including Coxiella burnetii and Chlamydia psittaci; and parasites such as Plasmodium knowlesi, a zoonotic cause of malaria. HIV is a big part of the story; Quammen devotes the last quarter or so of the book to tracing the discovery and transmission of HIV from primates to humans, and from 1900 to present-day. He even takes the time to explain the basic reproductive number–something that’s not always a page-turner, but Quammen manages to do it well and without being too tangential to the rest of the story; much more of a Kate-Winslet-in-Contagion than Ben-Stein-in-Ferris Bueller delivery.

Indeed, “Spillover” is somewhat unique in that it doesn’t read quite like your typical pop science book. It’s really part basic infectious disease, part history, part travelogue. Quammen has spent a number of years as a correspondent for National Geographic, and it shows. The book is filled with not only well-documented research findings and interviews with scientists, but also with Quammen’s own experience in the field, which gives the book a bit of an Indiana Jones quality. In one chapter, he details his adventure tagging along with a research team to capture bats in China, entering a cave that “felt a little like being swallowed through the multiple stomachs of a cow.” This was after an earlier dinner in which he describes his encounters with the an appetizer of the “world’s stinkiest fruit” (I’ll keep the description of the smell to myself) with congealed pig’s blood for a main dish (bringing to mind the scooping out of monkey’s brains in “Temple of Doom”–and the various zoonotic diseases that could be associated with those, come to think of it).

Quammen’s book is an excellent, and entertaining, overview of the issues of zoonotic disease–why do they emerge? Where have they come from? How do they spread? The only thing that’s missing is more of a cohesive discussion about what to do about them. However, that’s rather understandable, as we certainly have less of a grasp of this question than we do about the others (and even with some of those, our knowledge is spotty at best). I hope “Spillover” will inspire another generation of future germ-chasers, as “The Coming Plague” did almost 20 years ago.

Margulis does it again

We all know of once-respected scientists who ended up going off the deep end, adhering to an unproven idea despite massive evidence to the contrary. Linus Pauling and his advocacy of megadoses of Vitamin C, or Peter Duesberg’s descent into HIV denial. It’s all the more disappointing when the one taking a dive is a woman, since there are, compared to men, relatively fewer female “big names” in the sciences. So when one goes from views that were, perhaps, outside of the mainstream (but later proven largely correct) to complete science denialism, it makes it all the more depressing. Even worse, mainstream popular science magazines like Scientific American (with this article by Peter Duesberg) and Discover (Duesberg again) give these ideas reputable press. And now Discover has done it again by giving “maverick” biologist Lynn Margulis a profile in their latest issue. More after the jump.
Continue reading “Margulis does it again”