Markers of World AIDS Day

HIV (Human Immunodeficiency Virus) infection remains a major global public health threat. It is now known that the virus seeks and kills white blood cells of the human immune system, making the body defenceless against attacks by most micro-organisms from the outside and cancer promoters from the inside.

Since the 1980s, the final stage of HIV infection, referred to as acquired immunodeficiency syndrome or AIDS, has inflicted 70 million of the world’s population and claimed the lives of more than 35 million.

When HIV was first identified as the cause of AIDS by Dr Francoise Barré-Sinoussi and her one-time mentor Dr Luc Montagnier at the Pasteur Institute, Paris, it was thought to only affect specific groups, such as gay men. Hence, Gay-Related Immune Deficiency (GRID) was initially used to describe the affected individual.

Later, it was discovered that HIV could also be transmitted between heterosexual couples, through transfusion of infected blood and from a HIV-positive mother to her baby. Hence, HIV-AIDS seems to be the more appropriate description, and those afflicted by the virus are referred to as people living with HIV (PLHIV).

In 2017 alone, globally there were approximately 35 million PLHIV. Almost one million deaths were attributed to the virus. Also, 1.8 million people became infected with HIV in the same year, at a rate of 5,000 per day.

Normally, about half of new HIV cases involve the so-called “key populations” and their partners. According to the World Health Organization (WHO), “key populations” are people who are at high risk of contracting HIV. They include men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and their clients, and transgenders.

In Malaysia, since the virus was first detected in 1986 till 2017, the number of PLHIV was around 87000, with a 30% increase from 2000 to 2015.

In 2000, PLHIV in this country were predominantly male (90%) but the male-female ratio gradually balanced out in the following five years.

The previously higher number of male PLHIV was probably due to HIV transmission mainly through injecting of drugs using contaminated syringes.

However, due to the relative success of harm reduction programmes among this group of high-risk key population, the main mode of virus transfer has shifted to promiscuous sexual practices and unprotected sex.

The Health Ministry must be congratulated for its tireless efforts in taking care of PLHIV. A sizable budget has been allocated to ensure PLHIV receive adequate therapy.

The sustained adoption of PLHIV management, known as highly active antiretroviral treatment (HAART), has achieved commendable success. Due to the improved method of treatment and care, there was a drop in deaths related to AIDS from 5,200 in 2000 to 4,400 in 2017, a decrease of 15%.

Dec 1, 2018 marks the 30th anniversary of World AIDS Day, a day designated by the WHO to raise awareness about HIV and the resulting AIDS epidemic.

This year’s World AIDS Day coincides with two interesting events. First is the screening of Bohemian Rhapsody in local cinemas. The movie is a film biography of the British pop group Queen and the life of its flamboyant songwriter and lead vocalist, Freddie Mercury.

It is thought that Mercury contracted HIV at the peak of his career during the heyday of Queen in the 1980s. Mercury was believed to have kept secret his debilitating health status and continued to produce excellent music and perform in live concerts.

In the 1980s and 1990s, secrecy was the most obvious option as the HIV epidemic raged throughout the world like wildfire, fuelled by fear, stigma and ignorance of society at the time.

On Nov 24, 1991, a day after he announced to the world that he was HIV-positive, Mercury died from pneumonia as a complication of AIDS – at the young age of 45.

Hence, for this year’s World AIDS Day commemoration, WHO and its global partners have adopted the theme “Know Your Status”. The aim is to encourage people to determine their HIV infection status through early testing to improve the chances of treatment and success of care.

The second event that somewhat relates to World AIDS Day 2018 is the announcement by a scientist in China of the creation of the world’s first genetically edited babies. The researcher, He Jiankui of Southern University of Science and Technology in Shenzhen, reported that he successfully altered embryos for seven couples comprising HIV-positive fathers and HIVnegative mothers during fertility treatments. He alluded to the stigma linked to HIV-AIDS in China and how important the family is to society, hence his motivation to adopt and implement the technique.

The ability to manipulate or modify genes was developed during the second half of the last century. But in the last decade, this capacity, which is akin to gene editing, has been simplified further.

The technique, referred to elegantly as CRISPR-Cas9, allows the enabling of useful genes and disabling the problematic ones. This capacity to pick and choose genes is highly important in the medical field to deal with gene-related diseases. Unfortunately, this ability is also open to abuse if not properly regulated. Hence, though He Jiankui’s revelation, if validated, would seem like a medical breakthrough, concerns have been raised over the safety and morality or ethics of the technique.

The legal and ethical perspectives of human genome editing have long been debated. On the one hand, gene editing could be useful in preventing genetically-linked diseases. On the other hand, gene manipulation may result in malfunctioned or “off-target genes” that may not only cause harm in the individual concerned but also in the offspring of future generations. Worst still, these mutated genes might contribute to the development of cancer cells.

Since previously there have been calls for a moratorium on the application of CRISPR-Cas9 gene editing in humans until all safety aspects have been ascertained, He Jainkui has seemingly jumped the gun.

Bioethicists or the National Bioethics Council of the Energy, Science, Technology, Environment and Climate Change Ministry need to put on their thinking caps quickly to come up with a solution to the CRISPR babies’ conundrum.

ABU BAKAR ABDUL MAJEED Brain Research Laboratory Faculty of Pharmacy Universiti Teknologi MARA