From: nelson_p@apollo.hp.com (Peter Nelson)
Subject: Re: aids conference in cuba
Date: Wed, 29 Jul 1992 15:18:12 GMT
Organization: Hewlett-Packard Corporation, Chelmsford, MA

In article <1992Jul29.062935.27767@oracle.us.oracle.com> mfriedma@uucp (Michael Friedman) writes:
>In article <Bs3rqC.7yw@apollo.hp.com> nelson_p@apollo.hp.com (Peter Nelson) writes:
>
>>  1.)  It can take anywhere from a few months to 4 years (in one study)
>>       to seroconvert and the blood tests are still antibody tests
>>       so the blood supply is NOT compeletely safe.
>
>Seems like a good reason to use harsher measures to protect the blood
>supply.  For example, criminal charges against people who lie about IV
>drug use or past sexual history whe giving blood.

  Maybe so, although whether such sanctions would have much impact on 
  on people who are under a death sentence anyway, or even on drug users
  who daily engage in illicit activity, is doubtful.  In any case, this
  is academic since these sanctions are not in effect.  My point still
  stands:  "innocent" people are not safe.


>>  2.)  A drug resistant form of TB which is 50% fatal with the best
>>       current treatment and costs $100K a year to treat, anyway, 
>>       is spreading rapidly, due to AIDS, and you CAN catch TB
>>       by casual contact.
>
>However the people who are most susceptible are AIDS victims.  That's
>why AIDS is making it spread rapidly.
                                     
  AIDS victims catch everything more easily.  That's academic for TB
  though because TB is still very easy to catch for people with healthy
  immune systems.  

>                                      People without AIDS who get it
>are typically those who spend lots of time in close quarters with AIDS
>victims.  For example, prison guards.    

  . . . subway riders, hospital workers, anyone who eats food handled
  by an infected person, kids in classrooms etc.  You're too young to
  remember when TB was one of the major scourges of the world.   



>>  3.)  There is now evidence of a new form of HIV for which there is no
>>       test.
>
>And which is incredibly rare and for which there is expected to be a
>test within months.                      

  Maybe there will be and maybe there won't.  The point is that it doesn't
  exist now.  The other point is that if this is, as has been suggested,
  a variant strain of HTLV-III (HIV) then we can expect more and more
  of these things, as the world population of HIV+ people grows.  What
  we're doing now is running a vast, worldwide breeding experiment for
  HIV.


>>  4.)  HIV mutates 5 times as fast as influenze and there are 10's of
>>       millions of people in the world who already have it.  Simple 
>>       natural selection will always select for the most successful
>>       versions of a pathogen in terms of virulence and these are the
>>       perfect conditions to breed a "super" HIV, and inded this may
>>       already be occurring -- strains of HIV in Africa can already
>>       infect lung epithelial cells.  If a strain of some immunodeficiency
>>       virus that CAN be spread by casual contact develops then we're
>>       all in deep doo-doo.   Even if we just get one that's "only"
>>       as hard to catch as Hepatitis B (about 10 times easier to catch
>>       as HIV 1) we'll have a much bigger public health problem than
>>       we do now.   
>
>First off, natural selection also selects for the least lethal
>variants of a disease.  After all, dead carriers aren't very good at
>transmitting a disease.

  What makes AIDS different in this respect is that unlike most
  pathogens, the period from infection to illness, during which 
  the carrier is contagious but asymptomatic, is YEARS.   So I
  agree that one success strategy for a pathogen is to infect people
  but don't kill them; another is to infect them but wait a real
  long time to kill them.  The recent Amsterdam conference had several
  papers showing that the virus evolves AFTER infection into more
  virulent and lethal strains over time in an individual, so there
  is at least some empirical support for this risk.   There is
  no empirical evidence for a "milder", non-lethal strain developing. 

  I mean, I agree that there are evolutionary pressures in the
  direction you indicate.  But the thing to note is that these
  are NOT mutually exclusive.   It's the deadly, virulent version
  that we would have to worry about, even if the other strain 
  also develops.  
 


   
>Secondly, you seem to be presenting some very good arguments for
>following the Cuban model and quarantining all AIDS carriers.

  Except for three things:

  1.) the practical problem of where to put and what to do with 1.5
      million HIV carriers in the US.  

  2.) The fact that doing this would require a Constitutional and 
      major statutory changes, not to mention a major mindset change,
      whereas aggressively attempting to develop a cure would not.
      Cuba is a police state.  For a free country to take away 
      your civil rights for the "crime" of being sick opens up a 
      lot of scary doors.
                  
  3.) It doesn't really fix anything.  If an aerosol (respiratory
      vector) variety of AIDS develops, say in Africa since that's
      where it was found that lung epithelia was a target tissue
      type, that will spread all over the world; everybody would 
      have to be tested constantly and you'd end up quarantining 
      a significant % of the population.  


---peter



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