The Plague of Our Generation

My generation has seen a couple of pandemics and pandemic scares. From H5N1 influenza (the dreaded bird flu which never came to fruition) to H1N1 (the swine flu which did spread across the world) and from SARS to anthrax the media has time and again presented the danger that these agents have on world health. But truth be told none of these have had the impact from both a social and medical perspective than has the HIV pandemic. This year marks the 30th anniversary of the first reported instances of HIV in the US and I thought I would take a little time to remind everyone what this virus has done not only to those infected but how it has also been a pandemic with great social implications.

The story of HIV and AIDS begins fifty years ago in Africa. This virus has great similarity to a similar virus called the Simian Immunodeficiency Virus and it is widely agreed that fifty years ago, a virus similar enough to SIV evolved the ability to infect humans. Thus, some poor human in Africa came in contact with simian blood and with it came a new virus that would begin the worst pandemic in human history. Twenty years later on June 5th, 1981 doctors in the US started to note something very strange. In LA there were five patients with a peculiar case of pneumonia caused by a bacteria that wouldn't normally infect a human with a healthy immune system. Immune titers from these patients confirmed that all of those with the pneumonia had a severely compromised immune system, with white blood cell counts as low as 200 per uL, only 14% of what a normal count should be.

As media spread coverage of this strange new virus one thing started to stand out amongst the patients infected: they were gay. Not knowing what this new disease was it gained the name GRID, gay-realted immune deficiency, however later it became clear that the virus didn't only effect the homosexual population and the name was changed again. Still, the gay population became stigmatized for harboring this virus and the true face of HIV emerged. Freddy Mercury, the singer of Queen, literally took the knowledge of his infection to his death bed in 1991. Even today, thanks to the media, HIV infection has become synonymous with homosexuality, drug use, and sexual misconduct the end result of of which is invariably the contraction of HIV.


In the 80's the infection also became a death sentence. With no treatment available for this disease those infected could only wait until they became infected with a normally harmless bacteria and the body was overrun. Because of this, partners would leave each other once HIV was diagnosed seeing it as a mark of imminent demise given from the person they loved. Luckily, miracle drugs emerged that could prolong the life-span of the infected for years and years and HIV. Now, HIV is no longer a death sentence and has turned into something more of a chronic illness.

The human immunodeficiency virus  infects CD 4+ T cells, also called T helper cells. These cells are charged with the responsibility of helping clear foreign agents from the blood. The virus binds to the cell and fuses its membrane with the host cells, causing the virus to release a protein capsid into the cell's cytoplasm. The capsid falls apart and releases the true monster into the cell, it's RNA. The RNA genome is reverse trasncribed by a unique enzyme called reverse transcriptase and becomes DNA. Worse, the DNA is taken to the host genome and another enzyme called integrase inserts the genome into the host cell's. As the cell replicates, it unknowingly produces more virus particle by the constant replication of the host genome which now houses the virus's genome too.


The wonder drugs target reverse trasncriptase prevent the production of DNA, and thus any step that comes after. The identification of this enzyme proved a leap forward in the field of biology. The central dogma has always been DNA--> RNA --> Protein. That's the way life works. It's the schema that makes you you and makes me me. From skin to hair, every organism on Earth is under the influence of this genetic process. This is why when researchers said they found an enzyme that makes RNA into DNA (RNA --> DNA) the scientific community scoffed at it, unable to believe that the central dogma which rules all of biology at the level of the gene could possibly be broken. However, the scientists prevailed and would be rewarded with the Nobel Prize.

This enzyme also proves the be the necessary driving force behind the evolution of the virus. The problem is that reverse transcriptase does not have a proofreading mechanism like the DNA polymerases in your cells. In humans, mutations in DNA are bad so the machines that make DNA have methods of checking their work and fixing mistakes. But, in microbes eliminating this mechanism can proove beneficial. Since the replication rate of microbes is so much more frequent than any other organism, if you eliminate the proof-reading, you can potentially cause mutations that allow the pathogen to produce functional proteins but with slightly altered attributes. This could mean the ability to bind a different receptor or in the case of HIV, the evasion of drugs. This is why new drugs are constantly developed for HIV. Reverse Transcriptase can mutate the genome and prevent it from being recognized by the drugs.

Today in the US, the infection rate of HIV is down thanks to the scientific understanding of the virus and education of students about sexual health. However, we cannot hope to solve the pandemic unless we help those that truly need help. No region needs more than the countries in Sub-Saharan Africa which show higher rates if infection than any other region. It's up to the WHO to develop a plan to deliver the aid and drugs necessary to help. Not only that but we need education in the region too. South Africa employs a HIV positive Sesame Street character named Kami in order to achieve this end. Even here though there is a great divide between the rich and poor. 80% of the citizens in South Africa receive treatment from public clinics which are understaffed and not equipped to help all those in need. In a region that is skeptical about the actions of western culture, we must also be mindful of how we would instigate such an intervention.

Although we have the medical means necessary to fight the disease what it really comes down to is money. Poor people and poor countries cannot afford the drugs, a point satirized in South Park where the cure to HIV is "concentrated cash." Also, drug users that don't have access to clean needles are also at risk of contracting HIV and other blood-bourne pathogens. There needs to be an investment in the research for a vaccine to the virus as well as preventative care not only here in the U.S. but worldwide. It's only with this amount of cooperation that we can ever hope of nearing a day where the infection rate and mortality rate of HIV is 0.