Letter to the Editor, December 1, 2017: World AIDS Day

Image (c) CDC.gov, 2017 all rights reserved

By Ann A Kiessling, PhD
Director, Bedford Research Foundation

Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immunodeficiency Syndrome (AIDS) is arguably the most devastating virus humankind has seen during recorded history with more than 36 million people already dead and an equal number currently infected worldwide.  The evidence is good that HIV smoldered in chimpanzees for decades before jumping to humans.  Infected chimpanzees do not develop the deadly immune deficiency disease.

But, luckily, HIV is also a fragile virus.  Unlike the flu, HIV requires either intimate sexual contact or blood-to-blood contact to affect transmission.  HIV is rendered not-infectious by water, air, and soap, to name a few.  The best evidence that routine hugging, kissing and other household contact does not transmit infection stems from the families whose husbands and sons with hemophilia were infected with both HIV and Hepatitis C during the 1980’s by tainted blood-clotting factors.  Ten thousand men and boys with hemophilia (94% of the hemophilia population in the U.S. at the time) were infected before a test was developed to screen the U.S. supply of blood and blood-clotting factors for HIV.  Approximately 90% of the HIV-infected men and boys with hemophilia died before the early 2000’s.  The only HIV transmission reported in that population was by sexual contact from infected husbands to wives.

Like other sexually transmitted diseases, such as syphilis, gonorrhea, and chlamydia, the exact mechanism of sexual transmission of HIV is not understood.  What is clear is that syphilis, gonorrhea and chlamydia infections can be sexually acquired repeatedly by individuals with antibodies circulating in their blood against those pathogenic organisms.  This is counter to the dogma that vaccinations which induce antibodies in the bloodstream, e.g. against flu or measles or whooping cough, are protective against a second infection.   Hence, immune protection against sexually transmitted diseases is not conferred by the standard vaccination methods known to protect against other diseases, such as polio, flu, and smallpox.

Remarkably, despite the lack of a basic understanding of repeated sexual transmission of diseases to persons with antibodies against the disease, the National Institutes of Health has spent billions of dollars attempting to develop a vaccine against HIV.  More than 70 vaccine trials have already failed.

Fortunately, thanks to the HIV-infected men and women who demonstrated on the Bethesda campus of the National Institutes of Health (NIH) in the late-1980’s, government research funds were released for drug discovery.  Historically, drug discovery in the U.S. is left to pharmaceutical companies, not NIH-funded bench scientists.  Because of the release of federal funds for drug-discovery by basic scientists, in partnership with pharmaceutical companies for clinical trials of safety and efficacy, 22 new HIV drugs were discovered and brought to patient treatment within 2 decades.  This is an unprecedented rate of drug discovery and should serve as a model for other problems, such as the need for new antibiotics.

The success of anti-HIV drugs in decreasing the death rate from AIDS is nothing short of a miracle.  The death rate from AIDS in the U.S. has plummeted, although the rate of new HIV infections (on the order of 35,000 persons per year) has only decreased a little.  The single most important factor in limiting disease spread is persons knowing they are infected.  The Centers for Disease Control estimates currently in the U.S. there are 1.2 million persons living with HIV disease, but 15% of those do not know they are infected:  https://bit.ly/2AA7F2s

Hence, our current best defense against the spread of HIV is testing everyone. But, the Massachusetts Department of Public Health has made this more difficult to do in Massachusetts.

In the early days of the pandemic, persons could walk into testing laboratories anonymously and ask for an HIV test.  This had obvious benefits for the person being tested but denied the Department of Public Health knowledge about who was infected.  The Centers for Disease Control has always promoted anonymous HIV testing because their broad public health view is it is more important for persons to know their HIV status than for states to have a list of who is HIV-infected.  Hence, the CDC promoted the “over-the-counter” HIV home test kits.

The Bedford Research Foundation operated an anonymous, walk-in, HIV test program for many years, while based in Somerville.  About a decade ago, however, the Department of Public Health canceled anonymous HIV testing by invoking an old Massachusetts law that a laboratory test had to be ordered by a physician, not the patient seeking the information.  Hence, testing could be “confidential”, but not anonymous.  This view is not held by federal guidelines about laboratory tests.  Federal guidelines favor the view that the need for a physician test requisition is an expensive hurdle to individual’s access to information about their personal health.

Massachusetts is listed on the CDC website as belonging to the “next to highest” incidence of HIV infection in the country: Click bit.ly/2i4X1WC  to read the 22-page CDC brochure, Maps Based on Data from 2016 HIV Surveillance Report

As such, it is even more important to allow anonymous testing. Contact your state Senator Mike Barrett and Representative Ken Gordon to reinstate anonymous, walk-in, HIV testing in Massachusetts.

Editor’s Note: Panels from the AIDS Quilt will be displayed in the sanctuary at First Parish on Bedford Common, beginning on Sunday, December3 until Friday, from 10 am to 3:30 pm. The public is invited to visit the panels; please enter through the fully-accessible Elm Street entrance.

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