4 ms·

One note is there is no promise that a cure for HIV is possible, and if so, isn't potentially decades away. Drugs like this, and HIV as a manageable, chronic c

by Fomite 8y ago

One note is there is no promise that a cure for HIV is possible, and if so, isn't potentially decades away. Drugs like this, and HIV as a manageable, chronic condition have the potential to vastly change the face of the HIV epidemic. A bigger concern, in my opinion, is how you get the drugs necessary for this to a place like Uganda, where the per-capita annual health budget is $0.05.

lubos 8y ago
> where the per-capital annual health budget is $0.05 That surely must be a typo, right?
- Fomite 8y ago
  No. Malaria, HIV, myriad diarrheal diseases, vaccines. You've got a nickel per person.
  - lubos 8y ago
    https://www.newvision.co.ug/new_vision/news/1479921/budget-sh7-700-ugandan-medicine https://www.newvision.co.ug/new_vision/news/1479921/budget-s... It says $15 per capita.
    - Fomite 8y ago
      Then it's improved dramatically since I was told the figure I was told, which was admittedly a few years ago by the deputy minister for health. It seems hard to get a fixed number. Doing math off the Uganda MOH budget puts it at about $4. But it should also be noted that even the optimistic figure likely also includes things like hospital construction, money to pay healthcare workers, labs (and lab reagents), etc. that isn't what people normally think of. I'd really like my number to be wrong though. Because even $15 per person is...dire.
      - shaki-dora 8y ago
        Your number is definitely wrong, even by your own calculation. Why don’t you update your posts above, which just peddle some ridiculous stereotype of Africa? Your reasoning also leaves out that a lot of health care never goes through government coffers, both in African nations but also, for example, in the US.
        Fomite 8y ago
        I can't actually update the number - though I wasn't peddling some "ridiculous sterotype of Africa". I work in infectious disease prevention in Africa - and I got that number, as mentioned elsewhere, through the Ugandan MOH. That there are extreme constraints on funding is just true, and does impact a lot of decision making. For that matter, if you'd like me to talk about the way non-African healthcare systems are broken, I'm happy to do that as well, that just happens to not be what this thread is about. Also, the programs we are talking about rarely go through non-governmental sources.
    - Fomite 8y ago
      For those who desire an interesting and/or depressing breakdown: http://www.mmlonline.org/uploads/08%20Health.pdf.pdf http://www.mmlonline.org/uploads/08%20Health.pdf.pdf
      - dredmorbius 8y ago
        That's an expired domain. Might care to check your link, bookmark, or typing.
        Fomite 8y ago
        "This domain name expired on 2019-05-03 08:49:13" Literally expired last night. How frustrating.
        dredmorbius 8y ago
        Hah! I hadn't noticed that. Sadly, missed by the Internet Archive.
dokalanyi 8y ago
> like Uganda, where the per-capita annual health budget is $0.05 Ugandan here, didn't know this! Or hadn't calculated. But the public health system is really terrible. It's unbelievable. However, ARVs are quite available, I know people that have no trouble getting them for free.
- Fomite 8y ago
  They are, which is good. It's more a concern that the widespread availability of ARVs is somewhat dependent on the developed world still being terrified of HIV and thus heavily subsidizing treatment. Like a vaccine-preventable disease near elimination, I worry a lot about people taking their foot off the gas. And last I talked to HIV control folks in Uganda (several years ago, admittedly) there was a lot of concern about survivability meaning a dramatic increase in the prevalence of HIV, and thus the demand for ARVs.
boyband6666 8y ago
It's been 5 years but I rememeber being in a 2 hour talk (I used to work in vaccines) about the difficulty of coming up with a vaccine for HIV, never mind a cure. It sounded then like it was a long long way off, and we're still only just getting much more simplistic diseases vaccine preventable (malaria is what I'm thinking of, the new vaccine is only marginally effective, which may be enough to cut the cycle of transmission... or may not).
Loq 8y ago
potentially decades away Would you be able to sketch, in a sentence or two, why we can be reasonably certain about cures being difficult. Is there a specific reason? Are you similarly pessimistic about a vaccine?
- WhiteSage 8y ago
  Vaccines do well for diseases for which your natural immunity can protect you from them after you've created antibodies. HIV works the other way: the virus lets you create antibodies and then it wins the fight by hiding in your immune system and slowing turning the tables. The virus also stay dormant within your cells, and it is not absolutely clear where, yet. Other viruses which do this (chickenpox, herpes, papillomavirus, ...) are not cleared from the body by the immune system either, but at least the immune system can control them as long as it is healthy enough. This facts, of course, are no reason to be pessimistic about a cure/vaccine, just explains why it is taking that long. A cure might also pad the way to cure other diseases such as chickenpox and herpes, which may lead to complications later in life.
- Fomite 8y ago
  Among other reasons is that HIV is extremely bad at replicating itself without error. Which means, especially combined with the long-term nature of infection, a lot of genetic variation within a single person's viral ecology. Generally, it's much easier to develop a vaccine for more stable viruses. We might be able to target some sort of antigen on the virus that's highly conserved even with that mutation rate, but that's a big if.

by Fomite 8y ago

lubos 8y ago

> where the per-capital annual health budget is $0.05 That surely must be a typo, right?

Fomite 8y ago
No. Malaria, HIV, myriad diarrheal diseases, vaccines. You've got a nickel per person.
- lubos 8y ago
  https://www.newvision.co.ug/new_vision/news/1479921/budget-sh7-700-ugandan-medicine https://www.newvision.co.ug/new_vision/news/1479921/budget-s... It says $15 per capita.
  - Fomite 8y ago
    Then it's improved dramatically since I was told the figure I was told, which was admittedly a few years ago by the deputy minister for health. It seems hard to get a fixed number. Doing math off the Uganda MOH budget puts it at about $4. But it should also be noted that even the optimistic figure likely also includes things like hospital construction, money to pay healthcare workers, labs (and lab reagents), etc. that isn't what people normally think of. I'd really like my number to be wrong though. Because even $15 per person is...dire.
    - shaki-dora 8y ago
      Your number is definitely wrong, even by your own calculation. Why don’t you update your posts above, which just peddle some ridiculous stereotype of Africa? Your reasoning also leaves out that a lot of health care never goes through government coffers, both in African nations but also, for example, in the US.
      - Fomite 8y ago
        I can't actually update the number - though I wasn't peddling some "ridiculous sterotype of Africa". I work in infectious disease prevention in Africa - and I got that number, as mentioned elsewhere, through the Ugandan MOH. That there are extreme constraints on funding is just true, and does impact a lot of decision making. For that matter, if you'd like me to talk about the way non-African healthcare systems are broken, I'm happy to do that as well, that just happens to not be what this thread is about. Also, the programs we are talking about rarely go through non-governmental sources.
  - Fomite 8y ago
    For those who desire an interesting and/or depressing breakdown: http://www.mmlonline.org/uploads/08%20Health.pdf.pdf http://www.mmlonline.org/uploads/08%20Health.pdf.pdf
    - dredmorbius 8y ago
      That's an expired domain. Might care to check your link, bookmark, or typing.
      - Fomite 8y ago
        "This domain name expired on 2019-05-03 08:49:13" Literally expired last night. How frustrating.
        dredmorbius 8y ago
        Hah! I hadn't noticed that. Sadly, missed by the Internet Archive.

dokalanyi 8y ago

> like Uganda, where the per-capita annual health budget is $0.05 Ugandan here, didn't know this! Or hadn't calculated. But the public health system is really terrible. It's unbelievable. However, ARVs are quite available, I know people that have no trouble getting them for free.

Fomite 8y ago
They are, which is good. It's more a concern that the widespread availability of ARVs is somewhat dependent on the developed world still being terrified of HIV and thus heavily subsidizing treatment. Like a vaccine-preventable disease near elimination, I worry a lot about people taking their foot off the gas. And last I talked to HIV control folks in Uganda (several years ago, admittedly) there was a lot of concern about survivability meaning a dramatic increase in the prevalence of HIV, and thus the demand for ARVs.

boyband6666 8y ago

It's been 5 years but I rememeber being in a 2 hour talk (I used to work in vaccines) about the difficulty of coming up with a vaccine for HIV, never mind a cure. It sounded then like it was a long long way off, and we're still only just getting much more simplistic diseases vaccine preventable (malaria is what I'm thinking of, the new vaccine is only marginally effective, which may be enough to cut the cycle of transmission... or may not).

Loq 8y ago

potentially decades away Would you be able to sketch, in a sentence or two, why we can be reasonably certain about cures being difficult. Is there a specific reason? Are you similarly pessimistic about a vaccine?

WhiteSage 8y ago
Vaccines do well for diseases for which your natural immunity can protect you from them after you've created antibodies. HIV works the other way: the virus lets you create antibodies and then it wins the fight by hiding in your immune system and slowing turning the tables. The virus also stay dormant within your cells, and it is not absolutely clear where, yet. Other viruses which do this (chickenpox, herpes, papillomavirus, ...) are not cleared from the body by the immune system either, but at least the immune system can control them as long as it is healthy enough. This facts, of course, are no reason to be pessimistic about a cure/vaccine, just explains why it is taking that long. A cure might also pad the way to cure other diseases such as chickenpox and herpes, which may lead to complications later in life.
Fomite 8y ago
Among other reasons is that HIV is extremely bad at replicating itself without error. Which means, especially combined with the long-term nature of infection, a lot of genetic variation within a single person's viral ecology. Generally, it's much easier to develop a vaccine for more stable viruses. We might be able to target some sort of antigen on the virus that's highly conserved even with that mutation rate, but that's a big if.