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New antibody attacks 99% of HIV strains (bbc.com)
829 points by hexrcs 60 days ago | hide | past | web | 246 comments | favorite



HIV evolves with amazing (super-villian-ic) speed. Many "cures" attack 99% of cells, or similar. Resistance is evolved during treatment, and is usually uniform within just a few months. It mutates/evolves so fast that given just virus samples, it is possible to determine sequence of infection.

I think it needs to kill more than 6-9's before it has a good chance at being a cure.


I don't think this is relevant in that case. I am not an epidemiologist but I worked with people who were studying HIV. My understanding is that while the HIV mutates fast, it does not create new strains during the treatments.

A given strain can have some variability but will share general traits.

HIV strains are named and numbered: https://en.wikipedia.org/wiki/Subtypes_of_HIV

An efficient treatment against a specific strain would save millions of lives. An efficient treatment against the 99% of them that are the most prevalent would basically solve the epidemics.

The problem is that people often end up with more than one strain. This is why doctors tell HIV+ people to continue protect themselves and were worried about the appearance of "free-sex parties" for HIV+ individuals. Most people do not differentiate between strains but if you got HIV from a partner, you may have had only a part of their strains, you should not have unprotected sex if you want to maximize your chances.


Reminds me of a lesson about misleading statistics I tell my nephews. We've all see the hand sanitizers that advertize killing 99.99% of germs, but what does that actually mean? 99.99% equates to 1/10,000 survivors and assuming for each generation the population doubles means it takes just 14 generations for the original colony to be back at full strength again. For extra creepy effect, e coli can reproduce in optimal conditions as fast as every 20 minutes which buys you only a couple hours of hygiene[0].

Given this drug kills 99/100 HIV virus units, then this really only helps you for log2(100) or ~7 generations

The math is pretty easy, but the results are something that always surprise me: it turns out humans are pretty bad at estimating exponential growth.

0: real life conditions are probably slower than this, I concede.


> which buys you only a couple hours of hygiene

Which is long enough for you to complete your lunch! :-)


Is that even the claim they are making? I honestly never thought about it, but the claim could easily be "we kill 99.99% of germ strains" or "we kill 99.99% of germ cells".


I think the problem is that people tend to focus on the size of the numeric probability, as if it was intrinsically meaningful. And don't think to consider contextual details like in the example you give. It's the combination of the probabilities to the contextual details they're applied to that really matter.

Another illustration of that is, if 99.99% equates to 1/10000 survivors, the meaning of it depends on how many bacteria exist on the area in the first place. It has quite a different meaning if the typical number is 10000 vs if it's 100000000


> e coli can reproduce in optimal conditions

Then avoid dipping your hand into beef stew for too long. Most of time, germs grow like sigmoid function.


The idea is that it kills 99% of them, and then your immune system is up to the task of killing the remaining 1%.


But it's not a simple, linear battle.

That most virulent 1% then multiplies and infects systemwide... and adds new mutations all the time.


It's not the most virulent 1%, it's 1% which have unusual mutations that cause them to be resistant to this treatment, but which usually reduce their fitness in other respects. (This can be seen in humans as well, e.g. malaria resistance->sickle-cell). The fastest-multiplying viruses are also (obviously) going to be the most common, in the absence of treatment.


This is really fascinating how being really good at something often correlates with being less good at other things (in this case antibiotic resistance seems to be inversely proportional to the potency of the bacteria).

This is true not just for bacteria but also for other living creatures; for example animals that have lots of children have very short average lifespans.

It makes me think that every living species must be at the absolute cutting edge of its capabilities genetically-speaking.


Natural selection tends to work on traits that are relevant till the ability to reproduce ends. If the trait can dominate by rapid reproduction, life span does not matter and robustness is not selected for. Generally it is not an inherent trade-off between certain traits, apart from energy consumption.


My physics brain is now imagining some conserved quantity like the fitness density of a bacteria population. Lol


Interesting point. I hadn't considered unusual but useful mutations they accrued might come with reduced fitness in other regards.


It's like having superpowers, but with physical abnormalities. Like so many things, this was explored in the comics!


the marketing idea?


hand sanitizers aren't to replace soap, where as soap kills and washes surviving germs away


I'm not familiar with any details about this vaccine or other therapies, but from what I understand is when you have a partial solution or near total solution like this, you combined it with another therapy so you have two methods of action to dealt a "kill shot" to the target organism or virus. This combined therapy strategy is used in killing Borrelia type infections. Basically they combined two different antibiotics at the same time. Alone they are effective at relapse rate of say only 5% after 14 weeks, combined they can get near 1% or lower. Also when an organism evolves, its genetics can drift causing mutations that are disadvantageous. There a chance the mutation could make it more vulnerable to something just as well as immune to something else, and also there has to be consideration that there is a scenario where that can happen at the same time.


The article says they already combined three different antibodies to get the 99% rate.


HIV was/is an early hint at the computational complexity we face in understanding biology.

Not that we should consider in insurmountable nor ungrasp-able. But that we -- or parts of our society and professional institutions -- should lose some of our arrogance.

On the upside, that complexity also harbors enormous opportunity. Just, don't be simplistic about it an let your ignorance take you into disaster.


I'm always amazed at how many doctors I've encountered behave as if their knowledge is the extent of medical practice. I get it though, research is hard to stay on top of and isn't linear to results.

Granted, also, that there are lots of doctors who do follow research.


Most doctors are decision-tree driven, following the rules. If you get a truly insightful one, recommend the f out of him/her.


While your argument has some validity, the statement said "New antibody attacks 99% of HIV strains" not "New antibody attacks 99% of HI Viri (of a given strain)". The mutation would have to occur faster than the virus dies off.


I'm sure that it is much more complicated than this, but I wonder how long the virus can remain immune to all previous '99%' cures? Maybe eventually we could come up with enough of these and then administer them all at once.


> I'm sure that it is much more complicated than this, but I wonder how long the virus can remain immune to all previous '99%' cures? Maybe eventually we could come up with enough of these and then administer them all at once.

That's basically what HAART (the technique we've used to treat HIV successfully for the last 25 years) is. People take three antiretrovirals simultaneously. They're designed such that, for the virus to adapt to one, it has to make itself more susceptible to one of the other two.


> They're designed such that, for the virus to adapt to one, it has to make itself more susceptible to one of the other two.

That's not really accurate. HAART works because the 3 drugs are taken simultaneously, and it's extremely unlikely for a virus to get random mutations that confer resistance to all three in one generation.


> That's not really accurate. HAART works because the 3 drugs are taken simultaneously, and it's extremely unlikely for a virus to get random mutations that confer resistance to all three in one generation.

That is literally exactly what I said. The drugs are taken simultaneously, and it is very difficult to develop resistance to all three simultaneously, because becoming more resistant to one means becoming more susceptible to another.


Not sure if it's just miscommunication, or you misunderstand how HAART works, because you said "That is literally exactly what I said", and then in your next sentence repeat the statement that is false, "becoming more resistant to one means becoming more susceptible to another."

For example, suppose you take ATripla, which is a combination of efavirenz, emtricitabine, and tenofovir. If a viral particle has a random mutation that confers resistance to, say, efavirenz, that mutation does not make the virus more susceptible to emtricabine or tenofovir. The fact is the virus was already susceptible to those two drugs (that's why you take tests that specify your viral strain's pre-existing resistances to determine the best drugs for you before you start HAART), so it still is unable to replicate.

It's just a matter of statistics, not that resistance-granting mutations naturally make the virus more susceptible to other drugs.


I believe that's actually somewhat how AIDs treatments have worked. I'm not sure if all are like that but it's pretty much the exact logic.


Yep. Triple therapy is now standard in HIV treatment. The odds of developing mutations to 2-3 agents simultaneously are very low


When I was a teenager, I wrote a connect four game, and my brother would play it. Every time he'd win, I'd jump back into the code. I realized it was a fruitless cat and mouse (not only because the game is trivial) but because of the pacing of my "fixes" -- if I could have had the final version completed before he first played, he might have been stymied, but the iterations seemed to give him an easy path -- he only needed to solve one problem at a time.


Why don't we deliver all antibiotics as a triple? Wouldn't that eliminate antiobiotic resistance?


Antibiotics kill bacteria, not viruses. And that includes desired strains.


Probably for longer than we can keep coming up with chemicals that selectively kill it. After all, if we're not killed by the chemical, then that means it's possible to survive it.


That's not really a meaningful argument. You're talking about a large multi-cellular organism that has tissues, organs, and all that and comparing it to something that doesn't even have cells.


This is the fundamental problem with treatment of rapidly evolving diseases. The hope is that if you get a "good enough" treatment and get it out to the population rapidly enough, the disease won't have a chance to evolve and spread further. Herd immunity will bring it under control.

I think the problem with a widespread, highly studied virus like HIV is that a "good enough" treatment isn't "good enough." Any treatment will be deployed in a limited manner to test the efficacy, which will in turn give it a chance to develop a resistance and spread.

That having been said, if the treatment CAN treat 99% of current infections, it will be a boon for at least a couple generations of gay and minority communities in the developed world.


Hopefully it's cheap and/or Bill Gates starts throwing money into producing it if it passes clinical trials. I have a feeling that Africa is where AIDS does the most damage, and I doubt they can afford the $1000/mo. it will certainly cost in the States.


Antibody manufacture is not cheap. The antibodies are made by fusing the b-memory cells with mouse cancer, then putting the result in a bioreactor and filtering out the desired product, which must then be refrigerated. Drugs that use this technique commonly end in -MAB (for monoclonal antibody).


Given the entrenched nature of the American pharmaceutical industry, I'm unconvinced that any of them have actually tried to solve the problem of cheap antibody manufacturing at scale.


Why wouldn't they? Any reduction in cost is pure profit for them.


Reflexive paranoia rather than calm business analysis tends to rule the day when pharmaceutical companies are under consideration.


Are these monoclonals or polys? Does anyone have a paper ref?


Not that it helps Africa but in the US for a drug like Truvada (PrEP) it costs ~$1500/mo on insurance but they offer a copay card that covers $3600/yr which is enough to hit my deductible at least so after 2 months I only pay $30/mo but in practice I don't pay a dime because the copay card covers it all.


Honestly, when you US folks talk about how your medical bills work and are paid there is so much jargon and complexity it sounds like Star Trek techno-babble to my ears.

"I have a common but chronic ailment so all I had to do was re-route the phase-converter to the deflector shield and invert the chromaton particles in Shelk-Einstein space and we're done!"

:/


This is the real heart of the healthcare cost problem in the US. No party in the process knows how much anything costs, so it's unsurprising that costs go up so fast. This wouldn't be tenable in an individual pays environment, or in a government pays environment, but in the US environment where many people get coverage from employment we end up in this crazy system where there are so many parties involved in payment, that nobody knows what's going on.

In this case, the patient (A) may be getting the drug from a pharmacy (B), and the pharmacy bought the drug from the manufacturer (C), but the patient's insurance (D) is paying part of the cost of the drug, but so is the manufacturer, and insurance is paid for partially by the patient, and partially by the employer (E). There may also be direct government subsidies, and there are certainly indirect subsidies as well. Of course none of the 5 parties can really know how much anything costs, or how to reduce costs. Not to mention all the extra labor involved in administration of this complex system.


I didn't quite follow joshstrange's accounting so I don't know if this is what he's describing, but (unless it's been changed recently), in some states it's legal for manufacturer of an expensive medication to give coupons to customers to reimburse them for their copay.

This sounds like a nice, generous thing to do, but basically it means that the drug company is bribing the customer to force their insurance company to spend more money on their behalf.

So, imagine that a drug costs $1000 and the customer's copay is $200. The drug company can give the customer a $200 coupon to recover their copay and then raise the price of the drug to $1200. They've basically shifted the price from the customer (who decides whether or not to get the drug and is probably very sensitive to price) to the insurer. They make the same profit, but can probably sell to a lot more customers because it's "free". While they're at it, they could raise the price to $1500 or $2000, and it's still free to the customer.

I think this is a corrupt practice and it's crazy that it's even legal, but it's just one small part of the complexity and perverse incentives of our health care system.


and then raise the price of the drug to $1200

It doesn't work like that unless you're the only drug in class. If there are alternatives, then you'll get kicked off the formulary for a 20% price increase.


Oh, wow... never even heard of that one. What a horror show.


As a Canadian in the US to me this feels like a different kind of horror show. I play bridge and as a result I've been exposed to quite a lot of the elderly dying as a result of chronic conditions given the demographics of the game/sport. In Canada, it seemed we had a charity fundraiser 2-3 times a year for someone affected by some condition the government didn't want to cover due to cost. In the US, I deal with a level of convolution that might make the Byzantines envious but have a sense that the best plan on offer covers far far more than the rationed system in Canada. I think the Canadian system nets ahead on efficiency, but I'll quite readily admit that efficiency has some rather nasty tradeoffs.


There's certainly a discussion to be had on what level of care should be provided, how to pay for it, and what to do when the care required isn't provided.

I don't hear a lot of complaints about medicare not covering important things (but I only have limited exposure to that), and I assume a US single payer system would essentially be Medicare for all. I do hear complaints about Medicare not paying providers enough, and a lack of available providers.

A rational method of rationing care seems preferable to the current byzantine methods. My (likely naive) hope would be that spending the same amount of money on healthcare, but with fewer parties involved would provide more and better healthcare. At least we haven't reached the point where the government encourages smoking to decrease long term healthcare costs.


Remember how proponents of single payer like to point out that US government healthcare spending per capita is higher than many countries with single payer, even though it only covers part of the population? That's probably related.


> "I have a common but chronic ailment so all I had to do was [tech] the [tech] to the [tech] and [tech]"

Fun fact: A lot of the original Star Trek screenplays were written with [tech] everywhere and the science writers came in and tried to right some jargon that was believable.

In regards to health care, it's a mess. I spent years working in the industry and it's truly a little frightening. I've been in other country's systems before and recently put together a writeup on it:

http://fightthefuture.org/article/returning-to-america-and-t...


Healthcare is one of the reasons I'm not keen to consider moving to the USA for a startup job. Sure it would be a fun adventure compared to my current cushy contracting work in Australia, but healthcare in the USA is a show compared to the ludicrously easy and high quality coverage I have in Australia.

For reference, I pay about ~$200 Australian to my personal insurance, which is a pretty generous plan with lots of extras, basic health care such has visiting a doctor for prescriptions, etc... I haven't paid a dollar for in 3 years, before that I used to pay $20 for convenience of a clinic that was open late and they didn't bill the government for the entire cost, which is common, but almost always a reasonably small fee in the multiples of $20 depending on how long you spend with the doctor. I paid this when I was a government employee, a private employee contracted to the government, and I continued to pay it when I quit to become a freelance developer, my cover has nothing to do with my job and I cannot even fathom why in the most awful circles of hell I would want my health care tied to my job. Hence my trepidation at ever subjecting myself to the American health care system.


This. I'm having a chronic disease (type 1 diabetes) with a need for a CGM, an insulin pump and the fastest possible insulin analog. It's at least somehow doable here in Europe, even though it's lots of bureaucracy, but at least I get it even if I happen to lose my job or move to another city.

I know I might have good options for my therapy in US, but the risks are just too big and depending where you are the monthly expenses only for the insulin analogs might be just way too much in the worst case.


I'm curious what's the insurance / clinic you go to. I'm assuming it's not a usual bulk-billing one, but one related to instance?


So true... In Italy (or I guess most of Europe) you just go to the doctor and get it for free, if he thinks it's beneficial to your health.


Just be glad that retail pricing to American consumers subsidizes pruce-controlled health systems in the rest of the world.


Drugs are cheaper and largely subsidized by governments with high incidence of HIV.

*I'm South African, antiretrovirals are free.


Drugs are cheaper and largely subsidized by governments with high incidence of HIV.

I'm South African, antiretrovirals are free.*

Almost got it right: Drugs elsewhere are cheaper and largely subsidized by USA citizens.

Those drugs cost a fortune to make and the companies make their money in USA https://www.reuters.com/article/us-pharmaceuticals-usa-compa...


And yet, reportedly US pharmaceuticals spend more money on marketing and promotion (i.e. coddling up to the doctors who prescribe their products) than R&D.

https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

https://www.sciencedaily.com/releases/2008/01/080105140107.h...


God I wish this myth would die.

First off, that's not sales and marketing expense. It's what accountants called "sales and general administration" which yes, marketing falls into, but so do a number of other items. It's not 100% marketing.

Second, the only reason why a company would spend money on promotion is if the return is >100%. So, if drug companies were to stop all promotion, their profit would actually fall, not go up. So it's not going to reduce the cost of drugs.

Third, I've talked to a number of physicians would appreciate the marketing that drug companies do. They don't have time to keep up on the latest, so a 15 minute chat with a drug rep might save them a lot of time. Of course, they know the marketing is biased, but it at least gives them a sense as to what's out there.


> Second, the only reason why a company would spend money on promotion is if the return is >100%. So, if drug companies were to stop all promotion, their profit would actually fall, not go up. So it's not going to reduce the cost of drugs.

Not necessarily. Advertising is often a negative-sum game. To give a simplified, quasi-hypothetical example, if neither Coke nor Pepsi advertised, they would still have very similar market shares and revenues. But then Pepsi realizes they can spend $1MM advertising to swing $1.25MM of revenue from Coke, and Coke spends $1MM to swing $1.25MM revenue back, and now both companies are $1MM in the hole for no gain. In this case, everyone—Coke, Pepsi, and the consumer—is better off if the government just banned soda advertising. Well, maybe not the ad agencies, TV networks, and celebrity sponsors, but there’s still a net economic loss to society.

Lots of drug advertising is of this useless, competitive type. If no one advertised erection drugs, people would just go to the doctor and take whatever was prescribed to them. But if Cialis blankets the airwaves, they can swing market share from Viagra.


Except your example doesnt work. If coke and pepsi didn't advertise, more people would drink RC Cola and Faygo and fruit juice. Drinks are not a duopoly.


It’s a simplified example, but there is a point where cola-wars advertising turns into a negative sum game while still remaining the optimal strategy for each individual player. Coke and Pepsi can beat the smaller brands through distribution alone anyway.


> Almost got it right: Drugs elsewhere are cheaper and largely subsidized by USA citizens.

* Correction, by U.S. government (through law).

> Those drugs cost a fortune to make and the companies make their money in USA.

Yes R&D is expensive, but pharma is extremely profitable. Here in the U.S. and abroad.


The difference in pricing is STAGGERING. http://timesofindia.indiatimes.com/india/New-Hepatitis-C-dru...

The blockbuster hepatitis C drug will cost about $900 (around Rs 54,000) in India for a 12-week course of treatment. That would be a fraction of the $84,000 (over Rs 50 lakh) price tag for the same treatment in US.

I'm sure that they wouldn't be that profitable if USA paid $900 for that drug, especially the first few years.

https://www.nytimes.com/2015/02/04/business/sales-of-sovaldi... 140,000 patients in USA and going to 250,000


Drugs are cheapest in India. Let's normalize. I.e. far end of the pricing bell curve.

But the answer is still, yes, there is profitability. Just not as much as with the hyper inflated prices in the US.

In short: Does the extreme cost for drugs in the US cause groundbreaking research to benefit the whole world?

No, same results could be had with way less profit. Money to fund moonshot research is still important though.


Given the lower labor costs and people consider drugs to be so profitable, I don't know why other countries don't do as much research and drug development. Just a few countries carry the lion share of this effort.


That would be my response. If someone else can improve R&D and lower the cost of drugs, they are more than welcome to. Interestingly, I haven't seen any takers.


This is constantly done... Find some new discoveries in basic science. Get finding. Develop a drug. Test and redevelop. Market. Profit.


Based on lowering the costs of R&D? I've yet to see it.


Yes, many people bring their work out of academia and have much lower cost of R&D because they don't have to pay for any of the pre-work.

Reagents are getting cheaper and better as well.

Yesteryears low hanging fruit costs the same as today's low hanging fruit. They are harder to solve though.

And no, I'm not saying everyone single biotech startup is like this or every single researcher does this. And yes many fail, but that's the cost of doing business and it's something that makes things progress.


Drug development is expensive.


pharma is extremely profitable

That's survivorship bias. Yes, the successful pharma companies are quite profitable, but there are 10 failed companies for every successful one.

I remember reading a paper that said the overall returns for the industry are either single digit or negative.


This is business in general.

The big ones buy up the small generic producers and single new drug companies and get slightly bigger.

The ones who can't pass trials fail. That's business, especially in R&D.


Even poorer countries..? South Africa is not exactly was I was referring to. More like Congo, Senegal, etc.


ARVs (antiretrovirals) are free in Uganda. They are also manufactured right there


South Africa has the highest population of AIDS sufferers. That's why they're a good example.


If this is produced by Pfizer or some other company he is invested in, sure. Otherwise he will fall back to talking bs all day long like he does with Malaria.

For those downvoting: His foundation made sure the WHO subcontracts all studies to companies he has a stake in. He isn't a saint, he is a capitalist.


> Otherwise he will fall back to talking bs all day long like he does with Malaria.

Can you elaborate on this? I thought he was a type of person who does more than he talks.


Sure, The Bill & Melinda Gates Foundation is used for tax evasion, supporting corporate interest in developing countries and to control the WHO.

https://www.globaljustice.org.uk/sites/default/files/files/r...

They even advised not to lower prices for vaccines, because then pharma corporations wouldn't invest in the global south anymore.


If you have evidence of tax evasion, I'm sure the tax authorities would love to hear about it.


I guess they mean tax avoidance


Ah, yeah, maybe. I wonder if people know that non-profits, especially those that are that large, are given heavy financial scrutiny and that they can actually check the financial information themselves? The foundation will have a link to download their financial information and, given the levels of oversight and mandatory auditing, they are almost certain to be accurate.

The Gates Foundation does great things. I've never understood the complaints. They are pretty heavily scrutinized and their actions are fairly public. It's not some nefarious organization, at least it isn't from what I've read.

Edited to add: Hmm... They responded with a stange, now dead, comment. I am no longer sure what they meant. It'd appear they think Jobs is my false god. I remain baffled.


What if he has a stake in companies that he believes are getting it right, and that's why he would make sure they would be the ones getting the job?

He's doing it to win a Nobel prize, not for money.


Can someone knowledgeable provide more details about the "tri-specific" nature of the attack and what effects this might have on the selective resistance of the remaining strains? (e.g. is it something that would take three simultaneous mutations to overcome, thus being much less likely than any resistance that only takes one, due to HIV's incredibly high mutation rate, though those that do achieve all three would still be resistant?)


I cannot personally do so, but I know who can and almost certainly will. The 'This Week In Virology' podcast. It's run by the head of the Columbia University virology department and a few other respected researchers in the field and is an absolutely phenomenal resource whenever there is news about virology. It doesn't look like they've covered this yet (too new) but I expect it to feature large in their next episode. If you're interested in a real technical dive into the topic, that is the place to go.

http://www.microbe.tv/twiv/

(Related personal anecdote and why I recommend them so highly: I'd been listening to them for awhile, then a research paper came out showing a possible link between Chronic Fatigue Syndrome and XMRV in mice. People online had taken the paper and went crazy with it and some people were finding sources for murine (mouse) cancer drugs and dosing themselves with it in hopes of curing their CFS. They went through the paper and recognized the researcher and lab who wrote it. And noted that the lab had previously published XMRV research. XMRV is apparently remarkably difficult to eliminate contamination from. Basically if a lab has ever worked with it, you have to burn down the lab and build anew if you want to be sure it isn't around. So they advocated skepticism and said wait for independent verification before getting too worked up. A couple months later, the original paper was retracted as the researchers announced no other lab could reproduce their findings and it was down to XMRV contamination of their samples. That is the kind of thing you only get when you're listening to bona fide experts in their field and it blew my mind.


This is why I love HN. Thanks for the resource!


Right. There's almost always someone that can do a deep dive on an interesting, esoteric technical topic. No resource on the web like it with this level of diversity and depth.


What else does it attack?


The study looked at SHIV, so they did it in monkeys. A little different. I haven't looked at most of the study but I would imagine that as an antibody it would have some sort of specificity.


HIV must be the most almost cured disease ever.


In the 1980s, getting HIV was a quick death sentence.

In the 2010s, getting HIV means that you are likely to live until... Your 70s. (Assuming you have access to medication.)

The problem is that you need to take expensive medication for the rest of your life. And that you can infect other people.


Successful treatment means you cannot infect others:

https://www.reuters.com/article/us-health-hiv-transmission/p...

This is why "treatment as prevention" is important part of stopping further spread.


The infecting other people is mostly theoretical. As far as I know there is no actual instance of transmission from a person with an undetectable viral load on antiretroviral drugs to an uninfected person.


Is this somewhat of a tautology, though? I mean, it's not particularly uncommon for a patient to be undetectable on HAART and then have their treatment regimen "fail" at a later date (often because of lack of strict compliance by the patient - not sure if this is much less common today with easier-to-follow regimens).

Thus, if someone is undetectable but then their treatment fails, they would become detectable and able to transmit the virus. But they could still infect someone else before they discovered their treatment failed.


It even works the other way around. IIRC, there have been something like 2 documented cases of HIV(-) people becoming seropositive while taking PrEP as prescribed.


> an undetectable viral load on antiretroviral drugs to an uninfected person

Can you please put this into simpler terms? I am pretty confused. Because HIV transmission is not a theoretical and is not a myth. My understanding is, OP meant to say "transmission of HIV via known risky activities."

--EDIT--

Thank you for those clarifying. Often the unfamiliar technical terms can throw me off.


If you're getting treatment, the amount of HIV in your blood is regularly measured as your "viral load".

It's possible, with treatment, for people with HIV to have a viral load labelled undetectable.

To date, from an article I read, there have been no recorded transmissions from people with an undetectable viral load.

https://www.preventionaccess.org/faq


Two questions arise:

How many people taking retrovirals have undetectable levels of HIV?

Are those people using condoms?


The PARTNER study studied 767 serodiscordant couples, with the HIV positive partner undetectable. All participating couples did not use condoms at least some of the time. They found zero cases in which the undetectable partner infected the negative partner.

http://www.aidsmap.com/No-one-with-an-undetectable-viral-loa...

Frequent testing and early intervention are very effective to achieving an undetectable viral load. The adoption of these as public health policy, as well as making available of prophylactic measures for at risk populations, has been effective at combating the spread of HIV - e.g. in San Francisco, where infection rate has been declining significantly over the last 5 or so years.


Undetectable is the standard of care and is the definition for the treatment "working". Viral load is checked regularly after starting treatment. If it doesn't become undetectable quickly with first line meds, there may be compliance or resistance issues and treatment approach is changed. With current protocols the main reason for treatment failure is mental health/substance abuse interfering with adherence.

The studies on transmission are using sero-discordant couples who are not using condoms. The evidence/confidence has been building over time with multiple studies in which no transmissions were observed.

http://www.catie.ca/en/catienews/2016-09-06/negligible-risk-...

The HPTN 052 randomized study was halted early because the evidence so strongly favored the treatment arm. In the PARTNER observational study, no transmissions were observed in the study at all. The evidence is very strong.


Not a professional, but my wife has HIV (and I don't), so I have a personal interest in the subject.

> How many people taking retrovirals have undetectable levels of HIV?

According to my wife's doctor, most of them. And if that changes, they attempt to adjust treatment to return to that state.

BTW, undetectable appears to mean 20 copies of viral DNA per ml of blood.

> Are those people using condoms?

Well, we were, for many years. But we wanted children, and so after her doctor actually encouraged us we conceived them the old-fashioned way. I really, really enjoyed sex without a condom after so many years, I must say.

Now we have all the children we want, and we ought to go back to condoms, but I find myself wondering about the risk vs. reward. I suppose we'll go back to condoms, but I yearn to forgo them -- it's just less intimate. I wonder how other couples feel.


There was a study a few days ago that found out that below threshold viral load means that the patient isn't infectious anymore.

https://www.intomore.com/impact/cdc-acknowledges-that-undete...

Don't take my word for it though, would check with doctors.


They are responding to The problem is that you need to take expensive medication for the rest of your life. And that you can infect other people.

They are saying that there are no recorded instances of someone that is taking antiretroviral drugs and has an undetectable viral load actually transmitting the virus.


Interesting. What about mother-to-baby transmission?


Possible, but apparently more a theoretical risk. Certainly small compared to other birth risks.

Until a few years ago, C-section was recommended, but the current wisdom is that vaginal birth poses no greater risk for the baby.

Same with breastfeeding. Until a few years doctors would call CPS if a HIV+ woman admitted to breastfeeding her child. Now, our doctors encouraged my HIV+ wife to breastfeed.

OTOH she was the second (or third?) HIV+ woman in our city who dared to.

Worked out for us. Both kids are HIV-, as am I.


> In the 1980s, getting HIV was a quick death sentence.

It has never been quick.

> Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype

https://en.wikipedia.org/wiki/HIV/AIDS#Prognosis

You may be thinking of the ~1 year survival times after an AIDS diagnosis, but HIV is usually latent for a decade after initial infection.


The passing of the sentence was quick, the execution of it was painful and slow.


So exactly like an American death sentence.


In the 80s HIV wasn't really diagnosed until it had reached the AIDS level, was it? AIDS itself was first diagnosed in 1981 and HIV wasn't isolated until 1983 and didn't have that name until 1986.

I've tried to do a brief search for earliest HIV (non-AIDS) diagnosis, but many websites use AIDS and HIV interchangeably.


Sure, but vkou didn't say "being diagnosed with AIDS was a quick death sentence" Importantly, you could be practicing very unsafe sex for a decade with no apparent consequences, which is not what one would conclude from vkou's comment.


"And The Band Played On" might have something about it. I don't remember because I read it a lot time ago.


To be fair, "getting HIV" wasn't really a thing in the dark days. You found out when you developed AIDS, because some weird opportunistic thing popped up. Pre-AIDS diagnosis came along after an awful lot of people died slowly of things that folks ordinarily don't get or don't die from.


Well, 99% means eradication of the virus very quickly. People won't become totally sexually irresponsible after the preventive shot, because there are many other hard to cure STDs now, especially as antibiotics are not as potent as they use to be, so i think there is no threat of 1960s style of unprotected sex wave.


> People won't become totally sexually irresponsible after the preventive shot, because there are many other hard to cure STDs now, especially as antibiotics are not as potent as they use to be, so i think there is no threat of 1960s style of unprotected sex wave.

The way you've phrased this, it sounds like you are casting "other hard to cure STDs" as a protective measure against the "threat of 1960s style of unprotected sex wave."

Isn't sexual freedom a goal?


> Isn't sexual freedom a goal?

You always have the risk of undesired pregnancy and the best cure for that is the condom, since birth control pills are basically hormone bombs, not very healthy for women in the long run, or you could undergo surgery, which is invasive and not without peril. So just use the condom already, those minty ones are actually cool.

And if we don't have "sexual freedom" it's probably because there are really good reasons for it. We shouldn't dismiss taboos without considering that some of them is why we've survived for so long.


> And if we don't have "sexual freedom" it's probably because there are really good reasons for it. We shouldn't dismiss taboos without considering that some of them is why we've survived for so long.

If that's the way you want to live your life, it is fine. But don't try to impose your ideas to other people.


Do you feel like that about vaccines and people refusing them as well? Or what about smoking in public places?

Because the way I see it, this is more than the health of the individual at risk, being about the health of the group.


I didn't see you "imposing" your views on anyone. People can adopt what they will. I don't advocate for laws against free choice, but I am for social pressures against unprotected sex. It's a good thing, saves a lot of pain and lives and there's absolutely no need to apologize if someone wants to take that out of context. As if you're advocating for the police to round up sexually active teens.


> I am for social pressures against unprotected sex

What is this if not trying to make other people live their lives following your way of thinking?


I'm more than willing to bet you are happy to voice your opinion on any given subject, including this one as you try to snuff my viewpoint out with claims about my attempt at oppression. Why can't I add my own opinion and voice? Just because you don't like what I think.

This is the same misguided logic you tried to use on bad_user. You really don't get it and honestly I don't care if you ever do or not.


I find you comical that you are for social pressure to avoid behavior you don't like, but are complaining when others apply social pressure.

Free speech does not mean freedom from criticism.


You can find it as comical as you want but you're making the same mistake noncoml did. He said bad_user was trying to impose his view on others and that I'm trying to make people think my way.

bad_user and myself are both influencing others. We're not imposing anything at all. He's fine to criticize if he wants, that wasn't the issue at all. He didn't understand the difference between social pressure (which I'm advocating along with bad_user) and imposing. They aren't the same thing.

He's trying to split hairs with everyone on HN and not be intellectually honest so it's not worth discussing. Very easy to see what bad_user and myself meant. But the downvotes on noncoml's post speak for itself, most people are getting it.


I don't see how I'm making a mistake at all. What I found comical was your statements about social pressure in the context of your complaints.

Now you're repeating the complaints, and on top of that splitting hairs while complaining about others splitting hairs while doing so.

To me your responses just makes this whole exchange look sillier.


I don’t know man. I am just presenting my arguments. You are the one who is taking it personal, counting votes, and have to resort to personal attacks(“splitting hairs with everyone”, “not be intellectually honest”)

Just because someone disagrees with you, it doesn’t mean you have the intellectual honestly and he doesn’t.

Also, if it’s not worth discussing, just stop discussing. What’s with this passive aggressive statement?

Btw, since downvotes seem to be important to you: every single reply of yours in this thread is negative.


I did stop discussing, especially with you but here you are again. You just can't resist, which shows how you are. You're welcome to disagree, but you didn't just disagree, you said we were trying to force our will on others. That's called intellectual dishonesty and someone not worth spending time on. Meaning, you just want to argue. Go look through your post history and check the downvotes, not good. I'll leave you to it, good luck bud.


> I did stop discussing, especially with you but here you are again

You mentioned my name. What did you expect?

Furthermore I never said I stopped discussing, unlike you.

Finally, you are the one who is trying to split a hair: “Imposing your opinion” might be a bit strong, but it’s closer to “social pressure” than “influencing” is.

Discussing with you can be considered influencing.

“Social pressure” can be a whole town marginalizing you and your family because you are gay.

I don’t think I am trying to split hair. They are very different things.


Why do you think I am trying to snuff your viewpoint? How did I prevent you from voicing your opinion? My reply was just:

"> I am for social pressures against unprotected sex. What is this if not trying to make other people live their lives following your way of thinking?"

Yes, I really don't get it how is this preventing you to voice your opinion.

I honestly don't care what you think or support, but when you are suggesting "social pressure" in order for people follow your opinion then you will find me calling you out.


Yes, I do feel the same about vaccines. If nothing else a person should be a complete master of their body. But this is another conversation.

If you don't see the difference about public smoking and unprotected sex, then I don't think there is any point discussing this.

However your original comment sounded more concerned about morals than public health.

If it was the later and I misunderstood it, then please forgive me.


> You always have the risk of undesired pregnancy and the best cure for that is the condom, since birth control pills are basically hormone bombs, not very healthy for women in the long run, or you could undergo surgery, which is invasive and not without peril. So just use the condom already, those minty ones are actually cool.

Lots of women, including my wife, are perfectly happy with hormonal birth control. For others, there are lots of other options, and even more in development. It’s a very personal decision, but condoms are by far among the least effective techniques.

> And if we don't have "sexual freedom" it's probably because there are really good reasons for it. We shouldn't dismiss taboos without considering that some of them is why we've survived for so long.

The entire parable of Chesterson’s fence suggests that we shouldn’t get rid of something in society without knowing what function it was serving. It doesn’t suggest never reforming society at all.

The taboo against fornication is obviously there to prevent the spread of disease and unwanted pregnancy. If we have other ways to prevent these side-effects, there is no longer any reason for the taboo; much as the religious taboo of not eating pork or shellfish no longer serve the same useful purpose they did in the ancient Middle East.


I'm pretty sure birth control is safer than being pregnant every 10 months. From what I understand, this pregnancy thing is the real reason for the taboo against being sexually active more - that and society's penchant for knowing who to pass on their stuff to after they died. Granted, many of these sorts of taboos have traditionally been only for women and not men, and have not always been consistent over time. Additionally, old-time methods for birth control were bad, and abortion options (they have had them for centuries) were even worse. Pregnant women needed a lot of support as well, so this could lead to some of the taboo.

A condom is not the best option for birth control, merely one of the options. The best would be voluntary sterilization for both the man and the woman. There are other non-hormonal birth control methods, such as a copper IUD and other barrier methods that work, some better than a condom and some worse.

The main benefit from a condom is STD protection, but for that to be effective they need to be readily available to everyone and cheap enough to afford.


> birth control pills are basically hormone bombs, not very healthy for women in the long run

I've heard this a few times but I'm curious for sources on the fact that they're not healthy. They're certainly not natural, but, like, living until you're 80 years old isn't particularly natural either. Do you mind expanding on this?


Birth controll pills basically emulate a serial pregnancy- so im curious where this is suddenly unnatural.


The way you've phrased this, it sounds like you are casting "other hard to cure STDs" as a protective measure against the "threat of 1960s style of unprotected sex wave."

I read it as him casting the threat of those 'hard to cure STDs' as an incentive for people to not take the 1% risk of HIV infection.


I hope so. Although other communicable diseases will still be a significant issue, as time progresses it should be easy to love a person, even if only for one instance.


I just meant that a huge wave of unprotected sex could mean that remaining 1% to explode into a large threat. But it is unlikely as there are other factors deterring it, so if the article is true, that might really be the end for the virus.


Even if there were a perfect HIV cure, and antibiotics were 100% effective, there is a risk of infertility from chlamydia, etc.

So no, unprotected sexual freedom isn't a practical goal for medical science. Better to use condoms instead.


Unprotected sexual freedom is completely a practical goal; condoms work well but many choose not to use them, for better or worse. Prevention doesn't even need to center around eradication of the disease; it could come in the form of home detection kits. For better or worse people will always have unprotected sex with strangers. It's a thing.

I'm a little tired of the disconnect between medical advice and reality when it comes to sexual practices. Dental dams, anyone? Sure they're smart; I don't think I've seen one outside of health class. Doctors could easily provide more helpful advice.


Maybe in the age of nanobots will we have practical ways to allow for unprotected random sex.


> Isn't sexual freedom a goal?

For whom? Not for me.


I get the sense that you're hoping that someone will ask you to explain what you mean. So I'll do that.

What do you mean?


> What do you mean?

That I do not believe that sexual freedom is a goal.


Well, it is for others. Let's all agree then on freedom, because then those who want to pursue it can, and those who don't, needn't, and everyone is happy (except those, to appropriate H. L. Mencken's famous phrase, with the haunting fear that someone, somewhere, may be having sexual freedom).


I think the 1960's unprotected sex wave was more a symptom of ignorance of STDs. People used to see condoms as primarily for birth control, and not really a sanitary measure. Remember, the birth control pill came out in the 1960s!

Even then, knowledge of condoms wasn't widespread like it is now. My grandmother was super-pissed-off when my grandfather told her about them after she was pregnant for 18 months straight! She made it a point to tell me that I had to tell my future wife about birth control! (What made it funnier was that, at the time, if you didn't know what a condom was you were living under a very large rock!)


Ignorance of STDs was okay in 1960s, because antibiotics worked really great back then and just about every STD was easily curable.


This is being downvoted to oblivion but I'm not sure if it's true or not; hopefully someone can weigh in before it disappears.


Well hepatitis C wasn't and isn't easily curable, but i guess awareness of it was pretty low.


Is a stronger statement that hepatitis C is NOT curable, as it's a retroviral infection, thereby rewriting host DNA? [ Edit: i'd remembered incorrectly from decades ago: it's an RNA virus ]


>hepatitis C is NOT curable, as it's a retroviral infection

Hepatitis C isn't a retrovirus, so I don't understand what you're saying.


To be clear, hepatitis C now has a 95+% cure rate with modern treatments.


There's a cure for Hepatitis C since 2015.


Importantly, while the bacterial STIs were curable, Herpes was definitely not.


Herpes wasn't considered a disease at the time. It was not pathologized until later.


And HPV wasn't linked with cervical cancer yet - that doesn't mean it wasn't a disease. And I'm comfortable calling HSV-2 a disease based on the potential congenital consequences alone.

It's certainly a manageable one, and the stigma around it is silly, but if the common cold is a disease, then herpes is.


This is more or less true. The pharmacy company Burroughs Wellcome is largely blamed for pathologizing "genital herpes" starting in the late 70s.

https://broadly.vice.com/en_us/article/ypa8nb/did-big-pharma...


Wait a second. With heroes you get painful, oozing sores on your genitals. It sometimes never goes away and can flare up at any time.

Does it really take a company to make people think of it as a disease?

"Oh my penis feels like it's on fire and oozing all over me. However, I wouldn't call it a disease."


AIUI it wasn’t considered a disease similar to how cold sores aren’t.


Doesn't seem likely. Do you have data on this?


The 'sexwave' was in the 70's when studio54 was a thing and disco and cocaine became common/popular/big in the mainstream culture (famously captured by the film Staying Alive).

Also the legalization of abortion in 1972 contributed to this as well.


The 'sexwave' was all of human history up to the Industrial Revolution... then another in the 70s with development of the birth control pill and no known significantly dangerous STDs. Interestingly, the USA was viewed as the vanguard of sexual progressivism in the 1970s and places like France were seen as provincial backwaters. There's a great book about Frances attempt to modernize their views to be more progressive called 'Good Sex Illustrated'. If you're interested in the ways in which sex education can be stilted to promote extremely conservative antiquated mindsets, it includes a multitude of examples. It is remarkably relevant because it's basically exactly what American educators and parents inflict on kids today.


They may be referencing the Summer of Love (1967) and the Free Love movement which was, if I had to put dates to it, 1966 to 1972.

During those times there were lots of people having lots of sex. Unwashed sex with a string scent of sandalwood and patchouli, but still lots of sex, drugs, and rock n roll.

Then you had the disco era, fueled by fruity drinks and cocaine, sideburns, and lots of finger guns. There was still a bunch of sex. Those people would become yuppies, while many of the Free Love people would have moved into the woods to eat tree bark and become one with Gaia.


If there is no significant chance of untreatable disease, it is not 'irresponsible' to have a very active sex life. The irresponsibility stems purely from the danger. Without it, it becomes a moral issue and is quite different from 'irresponsible'. And yes, there are people who actively oppose any development of an HIV vaccine or cure due to their moral fear that people will start having more sex. The chaplain of the CDC announced in the 1990s that he would do anything in his power to prevent any research into an HIV vaccine, for example.

The most likely significant health threat as far as STDs go in the future are anti-biotic resistant gonorrhea. There were a couple of those spreading in Asia a couple years ago that were positively nightmarish.


"The most likely significant health threat as far as STDs go in the future are anti-biotic resistant gonorrhea. There were a couple of those spreading in Asia a couple years ago that were positively nightmarish." FYI, they're in the United States now and circulating.


... why does the CDC have a chaplain? It's a non-military government organization.


A chaplain is a member of the clergy that's attached to a chapel (hence "chaplain") or organization. The organization isn't necessarily military. Other examples include both branches of the US Congress, hospitals, and universities.


I disagree. I (annedoctally) heard several times stories about how today's youth (~20yo) doing more unprotected sex than my generation (~35yo) only because HIV "does not kill anymore".

If AIDS is actually curable, I would bet that all other STD would explode in the short term


There is also a sort-of vaccine for HIV called PrEP or something like that. I'm not sure how you get it but I've seen mention of people using it prophylactically (which is what its designed for). And really without HIV, there isn't too much to be afraid of. HPV has a vaccine for many of the dangerous strains, and the other strains infect the vast majority of the populace anyway so even calling them a 'disease' is arguable. Same with herpes. It's for life, but almost everyone has it. Gonorrhea, chlamydia, etc, are easily treatable except for the antibiotic resistant forms which are (thankfully) very isolated in their spread.

Aiming for 'less sexual activity' is a very bad goal. Abstinence is harmful. The tremendous health benefits of sexual activity are myriad. The amount of research backing up the idea that modern society is dangerously sexless is huge. One of my favorites was a study of ALL men, across all ages, socioeconomic groups, everything, of an entire town I believe somewhere in northern Scotland (maybe Ireland?)... those who had the most frequent orgasms had a 50% lower chance of having died of any cause over the 15 year period of their study. They also had very significantly reduced incidence of heart disease, cancer, and other health problems. But, of course, such things get reported as 'health benefits of sex' and not 'health dangers of abstinence' because they assume people are abstinent by default which is ludicrous. We'll know if public sentiment is changing when the headlines change.


> One of my favorites was a study of ALL men, across all ages, socioeconomic groups, everything, of an entire town I believe somewhere in northern Scotland (maybe Ireland?)... those who had the most frequent orgasms had a 50% lower chance of having died of any cause over the 15 year period of their study. They also had very significantly reduced incidence of heart disease, cancer, and other health problems. But, of course, such things get reported as 'health benefits of sex' and not 'health dangers of abstinence' because they assume people are abstinent by default which is ludicrous. We'll know if public sentiment is changing when the headlines change.

There seems to be a causality, but to me it is not obvious, what its direction is. The most healthy men, are probably also the most attractive.


Given the variety and abundance of studies, along with my reading on evolutionary biology, human biological history, and sexuality in general, I think it's a simple matter of 'we are built to be profoundly sexual creatures.' Just look at the facts of orgasm and I personally think it becomes clear that it has to be a critical bodily function. If you refuse to do anything to elicit one intentionally, your body will eventually take over and force one to occur in your sleep. That is not something the body does generally with other things except critical ones. There is certainly an argument that perhaps the purpose is to improve sperm quality in males, but females have nocturnal orgasms as well (though the mess after puberty makes it quite a bit easier for males to recognize it has happened).

We could have evolved to have a 'mating season' as almost all animals have. We could have evolved for females to give visible indication of fertility. We could have saved "wasting" the positively monumental amount of energy we pour into pursuing sex. We could have evolved so that sex was not even pleasurable but driven by instinct. We didn't have to evolve women going through menopause (and living a substantial amount of time afterward). Almost every single facet of human sexuality, if viewed through the lens of "sex is for reproduction", looks nonsensical if not evolutionarily suicidal. But through the lens of "sex is primarily for pleasure and social bonding," every bit of it makes sense. It explains why we stuck together in groups, the only thing that let weak, slow, stupid chimps without fangs, claws, venom, natural armor, or other similar natural advantages (except maybe endurance) survive long enough to have our social environment provide pressure for brain development and development of speech. We stuck together to preserve access to sexual partners, because it was pleasurable, and it made us the most powerful species on the planet. It makes sense that those who 'needed' it more were the ones to pass on their genes the most often.


PrEP (pre-exposure prophylaxis) is Truvada, which is part of the anti-retroviral regimen given to many HIV(+) patients. The idea is that any virions that enter your body are killed before they have a chance to set up shop.

It is a reasonably simple, safe, and effective drug, so it really should be available from any PCP. However, some community physicians do not prescribe it for one reason or another. HIV/STD clinics are almost always happy to see HIV(-) patients who are interested in PrEP.


Isn't there a lot of talk about how today's youth is much less likely to date/engage in sexual activity?

So what you're saying is, they don't always have sex, but when they do it's unprotected? That sounds pretty normal to me.


I think this is the time we should start using some data in this discussion, but my view is that people in their twenties are doing much more sex today. Due to tech (eg Tinder) and less stigma for sexually active women.


According to many articles that's a common misconception - that younger people empowered by Tinder can bang each other more and casually.[1] From my own anecdotes Tinder is actually a hindrance, since it creates a picture-oriented, extremely competitive environment where lack of physical attractiveness effectively shuts down the world of dating to the majority of men and women who aren't 8s, 9s, or 10s.[2]

I mean, on the net you'll often hear stories about kids scoring big but that's survivor bias. You don't hear anything from those who didn't bang.

[1] http://www.telegraph.co.uk/women/sex/no-sex-please-were-mill... [2] http://time.com/4435058/millennials-virgins-sex/


I'm at the age now where my friend's kids are getting to the sexually active stage of their life. They seem waaay tamer than what me and their parents were like at their age. I doubt that they are having more sex or even trying as hard. They certain Dont party like we did our have massive benders either.


> Isn't there a lot of talk about how today's youth is much less likely to date/engage in sexual activity?

could be but those two things needn't be mutually exclusive. maybe the youth is just more extreme in both directions whereas earlier people might have been more similar.


That's factually untrue according to the National Survey of Sexual Health and Behavior[0]. The facts are[1] that the younger the age group the higher the condom usage is.

And while condom use has fallen a little since its height, it still remains significantly higher amongst the young than any older generation or group.

[0] http://www.nationalsexstudy.indiana.edu/ [1] http://www.nationalsexstudy.indiana.edu/condomgraph.html


It's really hard to interpret that graph when you consider things like relationships and marriage, and that older people are probably more likely to be married.


My anedoctes are from Brazil (São Paulo), I don't think that paper's conclusion extends to a different group.


Not only that I've had friends on Truvada (PrEP) that use condoms less because they know they won't get HIV.


Why is that a bad thing? I don't know for the US, but in other countries you have mandatory tests (hepatitis, gonorrhea, many others) to do every 3 months in order to get the treatment. This alone makes you more protected than people who only use condoms as protection and think they don't need tests.


They only check Liver/HIV every 3 months (I have to ask for liver every 3, my doctor was going to do it only every 6). I make my doctor also do a full screening but by default he doesn't.


One could expect better indeed. Undiagnosed STDs can be nasty.


The concept doesn't exist in the States, sadly.

Americans please correct me, but here it's more symptomatic with sexual health: You have a rash/etc, so you go see the doctor. There's no early-detection system where you are reminded to get into a clinic every 2-3 months and get a full test (blood test, swabs, etc) for all the usual suspects: HIV, herpes, chlamydia, etc.


I live in Baltimore, and I'm on PrEP. Everyone I know who takes it, including myself, is required to get tested for STDs every 3 months.


I think that being on PrEP is the exception.


My friends weren't wrapping it when I was in uni 6-10 years ago because every girl was on birth control.


I am gay so I have used condoms my whole life but my straight friends routinely go out and have unprotected sex all the time, I'd say about 5% of my straight friends consistently use condoms.


It's a design problem. Sex with condom sucks. Non-condom sex is 10x better.

The real solution will be when you have male birth control available as well; and then it comes down to only having sex with people you trust. I great partner is better than a bunch of lousy partners anyways.


Don't they have vasectomy already?


Irreversible, so not a solution.

I'm 29, and so far every woman I've fucked, I ended up deciding I didn't want to marry / have children with. But that's still on the table like it is for the vast majority of men, so vasectomy is not an option.


As someone who came of sexual age in the 90s, between HIV and getting someone pregnant I was (and still would be - I'm married now so...) terrified of sex without a condom.


The other big factor people don't like to use condom is that it greatly reduced the sensation, regardless how the condom companies have been advertising it.


That's horrible, and nonsensical for the time period. With the amount of advocacy, and information available. Why would ANYONE consider not using a condom in uncommitted relationships?


Because it doesn't feel the same, duh. Might as well ask why people have sex at all instead of staying home safely and jerking off.


One reason is that the STDs you do tend to catch from casual uni sex are cured by a $20 pill, if that's even on your mind when you're drunk in someone's dorm bed.

"Shit, I got HIV/warts from hooking up" just isn't something I ever heard in uni. It just isn't part of the discourse. Those just don't seem to penetrate the uni bubble.

But everyone I know had to deal with the clap.


99% of strains isn’t necessarily 99% of all infections, and won’t be anything close to it soon after this gets used in humans.

If one assumes that the different strains also compete against each other the total number of infections may not go down much, and if it does, that may only be temporarily.


Not really, no. Modern antiretrovirals are exceptionally effective, and for those with access[1] HIV/AIDS has become a chronic illness, with nearly-similar lifespans (due mostly to chronic inflammation).

We still haven't come close to "eradicating" or curing HIV/AIDS; the issue lies in the virus' insidious biology. HIV is a retrovirus, meaning it incorporates into the target cell's genome, specifically CD4+ T-cells. An obvious barrier to "only" 1% of virions is that an infected person produces billions of virus particles every single day[2]. A less obvious barrier is the "latent" reservoir of the virus in cells.

Essentially, not all cells with an incorporated HIV genome are producing virus, and thus these proviruses can evade detection. A 2013 paper in cell[3] provides what I think is the most devastating example of this. Basically, an idea that has gained more traction lately has been to activate these T-cells, thus alerting the immune system and hopefully clearing the virus. It turns out that not all cells are activated, and the size of this reservoir is ~60X larger than previously thought.

When it comes to something like cancer, we often define "cure" or "beating it" differently — look no further than Randall Munroe's heartbreaking visualization, Lanes.[4] We need to do something similar for HIV. We can't get rid of the virus, but we're already pretty good at making life not so bad if you have it. Access and affordability are larger barriers to preventing mortality/morbidity.

There's also a quiet undercurrent that a standard vaccine for HIV is biologically impossible, but that's for another day.

tl;dr HIV sucks but we're okay at managing it. 99% sounds good but it's probably not enough.

1: Read: moderately well-off people with health insurance in wealthy, industrialized nations.

2: DOI: 10.1038/nrg1246 The oft-cited rule of the thumb is that every base of the viral genome is mutated every day.

3: DOI: 10.1016/j.cell.2013.09.020 This one is absolutely worth reading.

4: https://xkcd.com/931


>"an infected person produces billions of virus particles every single day... The oft-cited rule of the thumb is that every base of the viral genome is mutated every day"

Isn't it pretty weird that, despite this massive diversity, infections seem to be only caused a single, or sometimes a few, distinct virus particle(s):

>"we show that 78% of infections involved single variant transmission and 22% involved multiple variant transmissions (median of 3)" https://www.ncbi.nlm.nih.gov/pubmed/19193811

To me that means something is horribly wrong with our understanding of HIV.


Note that not all of those genomes continue to persist. People often have a single dominant strain, but what exactly that strain is varies wildly over time.


I'm saying that a person must be getting exposed to millions or billions of variants, and only one leads to an infection. That is very surprising to me given my understanding of viruses.


Even at 100% eradication would be very difficult. As far as I am aware, smallpox is the only disease we have successfully eradicated. If you count non-human diseases, this number climbs to 2 with rinderpest.

This is assuming that we can get the vaccine to everyone. In first world countries with developed and trusted this is mostly possible, but would still be a massive undertaking.


We were VERY close with Polio... but the CIA absolutely destroyed that when they ran a fake polio vaccination scam in Pakistan to get info on Bin Laden. Now it's making a comeback and doctors get shot trying to vaccinate.


We were also very close on measles, but politics and the anti-vaxx crowd have done a number on it.


Yeah, herd immunity is an interesting concept and one the anti-vaxx people completely hose up.

For example, a measles vaccine doesn't work on a small percentage of the population. Herd immunity says though that as long as some large percentage of the population is immune, those which the vaccine do not work will be fine. The anti-vaxx people end up pushing the percentage vaccinated below what's required for herd immunity and hose the whole population. Idiots.


Just to add a tad, the number needed for herd immunity differs by disease. For polio, you only need to get around 80 - 85% of the population immune before everyone is effectively protected. For measles, on the other hand, you have to get to 95%. That's one of the reasons polio is expected to be eradicated before measles, every % point higher is harder to get, so 95 is a tough goal to reach.


I was thinking that we need a stronger term than idiot, but it occurs to me that this behavior is actually criminal. It causes grievous harm to one's society, which is the criterion for criminal behavior. Therefore if social pressure is not sufficient to correct this behavior, legal means will need to be employed.


What about people's individual rights? I don't want the community to tell me what to inject into my body? (Ps I am NOT anti-vax)


Rights can be said to have a real existence only to the degree that society dictates, and only in a social context. Your will is not inviolate simply because you choose to frame it as a right. So the first answer to that question is that it must first be established that this is some sort of right that society has agreed to respect, and secondly you would have to take on the issue of the harm to society in order to argue whether the one or the other was more important.

Vaccinations are indeed something of an affront to one's physical person. So is collecting DNA evidence. I think that you will find upon further reflection that the physical integrity of one's body is not much affected by a vaccination, and that personal liberties do not extend to causing grievous bodily harm to others.


People that refuse vaccination on the basis of their rights should be perfectly free to do so, but on some isolated island where they do not interact with the rest of humanity.


> so i think there is no threat of 1960s style of unprotected sex wave

That's your takeaway from this interesting news? I don't understand how you jumped from this article to immediately drawing some opinions about sexual responsibility and behavior. The article has nothing to do with sex behavior, and HIV is hardly the sole deterrent for reckless sex.


"sexual responsibility" is quite an odd concept, it should be defined more precisely.


Children are the property of their fathers. Preserving the value of that property through preserving the virginal status of females is the responsibility of both sons and daughters. For a son to have sex with the daughter of another man, both the daughter and that boy have committed a property crime against the girls father. If she gets pregnant, he will never be able to get as big of a dowry when he sells her into marriage.

At least, that's where the idea of tying sexuality to economic considerations like 'responsibility' and phrases like 'saving yourself' come from.


Totally impossible for a term like "responsible" to have multiple meanings.

Obviously people mean the economic term. Couldn't possibly be the everyday meaning.


You mean bride price, dowry is what the bride's family gives


> no threat of 1960s style of unprotected sex wave.

Are you implying that unprotected sex is bad in itself?

Edit: It was an honest question.


Please default to the strongest possible interpretation of another's comment. Give them the benefit of the doubt. If you have an honest question that will move the discussion productively forward, please, by all means ask it. But if you're just looking to pick something apart, please just refrain from doing so. I find Rapoport's rules a good starting place for reflection on how to move a discussion forward, particularly on contentious topics:

https://www.brainpickings.org/2014/03/28/daniel-dennett-rapo...


> Please default to the strongest possible interpretation of another's comment. Give them the benefit of the doubt.

But... it was a question...

The topic is sensitive and you will see a lot of people hide their moral beliefs behind "health concerns".

I'd rather make a blunt and direct question rather than play hide and seek and be lured into a masqueraded conversation about morals and believes.


> But... it was a question...

Which is why I addressed this in the next sentence:

> If you have an honest question that will move the discussion productively forward, please, by all means ask it.

Does it move the discussion productively forward? What is the motivation for your question? Where do you expect the discussion to go from here? This isn't a question like "Where's the post office?" where the expected response is likely the effective end of the conversation. You're asking about morality. Do you think your parent has the same values as you? Are you looking to tease out some difference so you can argue about them? Show them that they're wrong? Find some points of agreement? Solve some underlying common issue? HN really isn't the place for general ideological debates. They're by definition off-topic. And regardless of what another has commented, we can show restraint and not continue a thread that is wandering off into incendiary weeds.

Edit (in reply to your addendum above): It does seem clear that you're looking for some kind of argument. Please don't. Let the thread die on the vine.

I don't intend to continue this any further. I do encourage you to review the link I provided, and perhaps review the recently updated HN guidelines, which includes similar points.

https://news.ycombinator.com/newsguidelines.html


> Does it move the discussion productively forward?

Yes.

> What is the motivation for your question?

To know if we are discussing about public health issues or moral believes. If it is the later, then there is no point continuing the discussion.

> Where do you expect the discussion to go from here?

If the motivation behind his comment was morals, then I don't expect the discussion to go anywhere. It is a dead end.

If it is about public health, we can continue the discussion.

You are doing the exact same thing you are accusing me of. It would be a good time to follow your advice: "Please default to the strongest possible interpretation of another's comment. Give them the benefit of the doubt."

As I mentioned all I wanted to know is if he is trying to have a discussion about morals or public health. Because if it is the first then I don't want to be part of the discussion.

(Edit in response to your edit) You are starting an argument on my post, and when I reply to your argument you make a passive aggressive edit to your post accusing me of not dropping the argument. And you drop it, by making a non-reply reply?


In a good-faith effort to clarify: my edit was in response to the additions that you made to your comment above (https://news.ycombinator.com/item?id=15315553), not to this reply. When I first composed my reply it consisted only of the line I quoted.

When I see that a discussion is not progressing constructively (as I observed from your first response to me), I try to make clear in a response that am indeed dropping the thread: I'm not interested in tit-for-tat back and forth, and know that it takes both parties to work toward a common goal for such discussions to be productive: I'm as much responsible as any other party. I do hope you find the constructive discussion you're looking for, and apologize for taking this off-topic as far as it has.


> When I see that a discussion is not progressing constructively (as I observed from your first response to me)

You offered unsolicited advice. I didn't take it personally, I tried to reply with arguments.

> I'm not interested in tit-for-tat back and forth

Just because I don't agree with the arguments you make it doesn't mean I have anything personal with you or that it is tit-for-tat or don't like conversing with you. Quite the opposite, the more difficult and challenging your arguments are, the more I enjoy the conversation.

Edit: Removed the "I am having doubts if you were interested in an open discussion in the first place." Please disregard it.


thank god.


This is also good news for people with elevated risks of acquiring HIV (such as people with Herpes). Hopefully they can use similar tactics to eradicate HSV and HPV next.


From a medical standpoint, HSV and HPV are largely cosmetic and very low priority. HPV is/was perhaps a slightly higher priority because it can rarely lead to certain cancers, but the vaccine Gardasil aims at those types of HPV.


Only four strains, not all strains. Others kill up to nine different strains, but that's still not all potentially carcinogenic strains.


Given the sheer diversity of HPV strains, I'm doubtful that we'll ever eradicate it, as a number of them are either genuinely or largely benign, and an out and out viral eradication campaign is a long term, sustained and global effort that is invariably very expensive.

Actually getting the vaccines that cover the high risk strains into the developing world is a much more obtainable goal, and even that is extremely challenging for a number of reasons.


Don't they have the HPV vaccine Guardasil?


Gardasil gives immunity to a few different strands of HPV, notably the most dangerous ones in terms of causing cancer risk. I do not know if it is reasonable to expect we will ever be able to totally eradicate all strains of HPV. Luckily most strains are, like most strains of herpes, innocuous. That's how they manage to infect the vast majority of the populace in the first place.


As of a few years ago, a new variety of Gardasil, called Gardasil-9 was approved by the FDA and it induces immunity against more varieties.


That's excellent! I had not heard of the newer version, thanks for the info! I was very happy when I saw that they finally started recommending parents vaccinate boys as well as girls. I never understood the initial hesitance. Sure boys might not have to worry about cervical cancer, but HPV is the #1 cause of oral cancer in males. And that's on top of just the general 'if you can protect your child from a prevalent disease with minimal risk, why wouldn't you?'


Nine of them, as one could easily deduct. There's dozens of HPV strains, most of them relatively harmless.


The clinical trials should be interesting. Hopefully it maintains efficacy.


I wonder if we can do the same thing with the common cold…


is 99% good enough? I thought cancer hides and comes back, so that 1% can grow again, so you still have to take the drug the rest of you life.


If a vaccine becomes available, I wonder if somebody will pay to help poor countries fight it.

I mean does the UN have existing programs that offer vaccines in the third world?

I mean it would be a shame to have a vaccine and not see it being used.


So does chloride.


Now that they're on a roll we need to get them on the cure for cancer!


Reddit discussion: https://www.reddit.com/r/UpliftingNews/comments/71neat/new_a...

I like how the ID is 71neat


Why would you link to that discussion? Here is what I see as the "top" comments:

  -what about that 1%? I'd fear if it became the new super HIV
  --Can you not appreciate the 99%?
  ---He's a 1%er for sure...
  ----Let's git im!
  -----ANGRY AT OP? WANT TO JOIN THE MOB? I'VE GOT YOU COVERED! COME ON DOWN TO /r/pitchforkemporium...
  ------Here you go Comrade
  -------!redditsilver
  --------Here's your Reddit Silver, ZarathustraV!
  ---------Good bot


unfortunately /r/upliftingnews isn't exactly the high-level discussion you're probably looking for.

thankfully, /r/science has you covered. https://www.reddit.com/r/science/comments/71ndtd/scientists_...


Thanks, I definitely should have linked to that.


Ah, good ol' Reddit.


Seems like I’m getting downvoted, so to be clear I just wanted to add a link to a relevant discussion. I really should’ve linked to the r/science one.


If it's any consolation, that link made me laugh hard.


haha, thanks!




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