HIV and ID Observations

A busy week for Infectious Diseases on television!

First, Dr. Aditya Shah, an ID doctor at Mayo Clinic, treated us to several snippets of truly idiotic ID-related drama in a network television show.

After seeing them, I commented:

Hey, my services to this show to help you talk about infectious diseases without sounding dumb are available at a very reasonable price.

My offer stands! For this show! And all of television! If you never want to sound stupid about Infectious Diseases again, call me!

For those of you who wandered over here to an ID blog without much ID background, here’s why the linked very tense hallway exchange sounds (and looks) particularly moronic:

• “Howard has a superbug.” Doctors hardly ever use this term. Yes, it’s commonly used in the popular press to describe a drug-resistant infection — but think of it like “germ”, another word you rarely (if ever) hear doctors say when talking to other doctors.
• “A C. diff infection?” He looks genuinely surprised, although C. diff is one of the most common infections in hospitals today. Plus, has there ever been a single clinician in the world who uses the term, “a C. diff infection”? Nah. Just C. diff.
• “It’s resistant to all medication.” The clincher! Because even though C. diff can be difficult to treat, this is due to alteration in the normal microbiome, not antibiotic resistance. We don’t even do susceptibility testing — which makes one wonder what could possibly be written on that piece of paper they are reading.

Second, the press picked up — in a big way — a paper that reported the discovery of a “new HIV strain.”

To clarify, it’s a new subtype, called “subtype L”, and it was identified by scientists at Abbott Laboratories using new techniques on stored blood specimens.

We have no reason to doubt their findings, which seem sound enough, and it’s a plus that our major diagnostic labs keep track of HIV genetic diversity.

But it’s hard to come up with other HIV research where the amount of news coverage (huge) was so disproportionate to the clinical impact of the finding (zero).

As my virologist colleague Dr. Jon Li says, “Media reports play on our fascination and fear of mutating viruses.” Perfectly stated! But to get back to the non-existent clinical implications, this “new” subtype L would:

1. be picked up by standard HIV diagnostic tests,
2. respond to antiretroviral therapy,
3. probably never be encountered anyway, since only three examples have been found, most recently nearly 20 years ago.

One of our local news stations chatted with me about it here — I think they did a good job reframing the “story” to be about more important issues in HIV today.

Next time they may want to speak to my mother, who commented:

Interesting news story in that it’s all negatives.
Not a new strain.
No change in diagnosis.
No change in treatment.
Not something to be worried about.

I told you she was smart!

Finally, we have another “brink of HIV cure” report, as a biotech company called American Gene Technologies (AGT) “submitted a nearly 1,000-page document to FDA.”

And within its pages just may lie the cure for HIV/AIDS.

It’s hard to comment whether this company’s immune-based approach to HIV cure will ultimately be a promising strategy — it’s in the very early stages of development, with Phase 1 studies tentatively starting soon.

But watch the accompanying video — which statements make you roll your eyes the most?

• “Since the late 1980s, a few antiretroviral drugs …” Look at this list! The word “few” means “a small number of” — there are way more than a few.
• “No treatment actually cures HIV — that’s until now …” Hey, we all hope for the best with this novel approach, but no one has been cured with it yet.
• “[Taking HIV drugs] is a life sentence of taking that toxic chemotherapy …” Yikes, this is overly harsh. Most people with HIV have few side effects from treatment, many have none. Plus, is the analogy of taking medication every day to imprisonment appropriate? Do we say people with high blood pressure have a “life sentence” of taking anti-hypertensive medications?
• “The single-dose drug has a simple purpose — to eradicate HIV once and for all so that people can live.” Aren’t people with HIV living now? Isn’t survival for people on treatment comparable to those without HIV?
• “We wanted to get these people out of jail and back to a normal life.” Good grief, he’s back to that prison metaphor again.

Before anyone accuses me of being overly skeptical about AGT’s approach, I am thrilled that scientists both in academia and industry are working on an HIV cure. And I’m hopeful a cure will one day be a reality for my patients and the millions of others with HIV — whether it’s AGT’s strategy or the work of other investigators.

But we definitely need cautious, scientific reporting — and way less hype.

Meanwhile, that Dr. Shah sure is funny.

Me, when the team wants to use unneeded meropenem #stewardmeme pic.twitter.com/rcoDaw7b07

— Adi (@IDdocAdi) November 9, 2019