#19 – HIV (2/2): From Death Sentence to Manageable Disease

00:00:06: So it's relatively tough to make these vaccines.

00:00:09: Many have been tested, there is a lot of work that went into this.

00:00:14: the field still very active but today no vaccine would protect humans from HIV.

00:00:46: Hello and welcome in this episode of Virological!

00:00:49: This was recorded on June fifteenth of twenty-twenty six in New York And so this is the second episode about HIV.

00:01:00: Last time we talked about the virus, We talked about disease and history of how the virus was discovered.

00:01:09: This time I would like to cover a little bit more of how things developed afterwards.

00:01:14: Just where do you stand right now?

00:01:18: In terms of vaccines, in terms of therapeutics, prophylactics and so on?

00:01:24: Just to recap a little bit, AIDS the disease was described first in nineteen eighty-one.

00:01:31: Of course it wasn't called AIDS at that point but the term AIDS was coined a little later.

00:01:37: and then nineteen eighty three and nineteen eighty four.

00:01:40: HIV the causative agent so human immunodeficiency virus.

00:01:44: one was discovered.

00:01:48: AIDS was a devastating disease.

00:01:50: This virus, this new virus HIV spread specifically in marginalized groups.

00:01:58: homosexual men were one of these groups but there are other groups that were affected as well certain immigrant groups hemophiliacs for example and so affects marginalized groups, and then in addition if not much is known about the disease.

00:02:17: And it seems to be super deadly which was the case with AIDS at the beginning... ...and can be spread through sexualized contacts.

00:02:27: It can also be spread over sexual contact.

00:02:32: You can imagine that there's a lot of stigmatization of the patient group.

00:02:37: In addition even beer groups because it was known that this disease was contagious and almost uniformly deadly.

00:02:47: It led to a phenomenon called social death, so people who were known to have HIV or who are know how to have AIDS basically not part of society anymore where even often by their beer groups ignored them.

00:03:04: So there is huge issue.

00:03:07: In addition during a time when these things were, I would say politically ignored.

00:03:16: Back then Ronald Reagan was US president and that he did not really officially acknowledge AIDS until You know, there was a lot of missing information.

00:03:35: There wasn't a lot Of missing policy that was not really A lot of bush starts to exceed development of vaccines and antivirals And because if that activism became very important?

00:03:48: So you have different groups of activists That were working on this issue.

00:03:54: One off course Was the homosexual community Because they were affected quite a bit.

00:04:00: They also vocal about it And one of the earliest groups that were founded to kind of push policy and push development of countermeasures was The Gay Men's Health Crisis group, which was founded by Larry Kramer in two years ago.

00:04:23: Initially this disease mostly affected gay white men.

00:04:30: There was a lack of information in Afro-American and Asian communities.

00:04:37: For example, the Black Coalition for AIDS Prevention and Alliance for South Asian AIDS Prevention were founded to make sure that information is spread in other communities as well.

00:04:52: This worked out very well that these activist groups were really able to push their agenda and make sure information was shared.

00:05:03: That this ended up to basically guide policy decisions, also pushed the development of vaccines and treatments.

00:05:14: One group founded a little bit later is the AIDS Coalition to Unleash Power or ACT UP.

00:05:22: That was also founded by Larry Kramer.

00:05:24: I think he became annoyed with the group that you had founded earlier, because it seemed like they were not moving as quickly as he wanted and so there are a lot of these groups who pushed their agenda forward And this is effective.

00:05:39: It led to change in policy.

00:05:42: The Affordable Care Act for example which helped people with pre-existing conditions get insurance coverage was a result of this activism, so super important.

00:05:54: What also happened is that when trucks became available and the viral drugs or potential anti-viral drugs not all of them were actually drugs in the end approved to work or were even licensed.

00:06:06: bias gaps where people got together started basically import Bosch Leibnz Magle potential antivirus and then distribute them.

00:06:17: And there's actually one example of a documentary, but I have the movie that came out.

00:06:26: this which is Dallas Bios Club Which is famous movie describes how one of these Bios Clubs developed?

00:06:33: Then in nineteen eighty eight so few years after first cases few years After discovery of the virus There was The First World AIDS Day.

00:06:42: So basically activist groups managed to really kind of put or get the public's attention on that topic, which was super important.

00:06:55: Unfortunately a lot people got infected during this time and even a lot famous people died from AIDS.

00:07:04: Just a few examples, Freddie Mercury for example.

00:07:09: I can still remember last album made in heaven the last Green's album.

00:07:15: When I was a teenager, bought that and it was super sad with the whole story of Freddie Mercury then dying of AIDS this being their last album.

00:07:25: Isaac Asimov died of AIDS Keith Herring died of Aids Michelle Foucault died out of AIDS.

00:07:31: so there are lots people during those times when they got infected but nothing could be done.

00:07:40: Point that is important to make, there are also people who didn't believe that AIDS existed or HIV existed.

00:07:47: So similar what we had during COVID-IX in a certain degree... There were lots of conspiracy theories.

00:07:55: some said that AIDS was not caused by HIV and no connection with other factors might cause AIDS.

00:08:03: others just basically say AIDS does not exist or HIV doesn´t exists.

00:08:08: And there was also some Soviet propaganda circulating that HIV is a result of the US bio weapons program, which of course it's not true.

00:08:17: But this was circulating as well and its worth mentioning two people who were really actively pushing HIV denialism.

00:08:28: One was Peter Duisburg German biologist virologist who worked at UC Berkeley The problem here actually a solid scientist, right?

00:08:38: So he had good reputation and He still pushed this this agenda that or this idea That AIDS was not caused by HIV but other factors.

00:08:49: And that did a lot of damage.

00:08:52: Then the other person who wasn't outspoken AIDS denialist was Kerry Mollies and thats also interesting.

00:08:59: Kerry Mullies invented the BCR Actually got to Nobel Prize for his invention but he also didn't believe that HIV was causing AIDS.

00:09:08: All right, so as I mentioned this early activism was really important to get the field moving.

00:09:13: But in terms of science a lot things were happening too.

00:09:16: One of them most important thing initially was to figure out tools develop diagnostic tools To actually detect infections and not only detect infections but also detect contaminated HIV-contaminated material.

00:09:34: for example blood products, right?

00:09:36: Blood transfusions but also blood products that were used to treat hemophilia and so on needed to be screened for HIV.

00:09:44: To make sure there was no transmission in that way.

00:09:48: And what was initially used is the antibody tests.

00:09:55: So basically when you get infected you turn antibody positive for HIV or the virus.

00:10:01: Unfortunately, these antibodies in many cases don't neutralize the virus or it doesn't help to get rid of the virus.

00:10:07: But at least they are biomarkers for somebody who is infected and of course in blood transfusions you can measure that as well so you can determine if the blood products come from someone who has been infected.

00:10:23: These diagnostic tests were approved already in US by FDA.

00:10:29: Of course, they got improved over time.

00:10:32: Initially I think that had a lot of false positives but there were super useful tool and still in use.

00:10:39: so measuring antibody responses to HIV is the main way for diagnosing HIV infections.

00:10:48: You can also directly detect the virus which goes back to Kerry Mullis.

00:10:54: So the PCR polymerase chain reaction was used in research as early in nineteen eighty-three to look for HIV genome.

00:11:04: But first nucleic acid tests, so basically a PCR based test of HIV for direct detection were only approved in two thousand and one by the FDA which was surprisingly late at least that's my feeling.

00:11:19: but when it became available.

00:11:22: And there are now relatively rapid tests available to diagnose HIV infections and they're widely available, and diagnosis itself is typically not an issue anymore.

00:11:34: These tests are typically very sensitive or specific so super reliable and super helpful because only if a person is diagnosed with HIV you can start this treatment that we make sure the person doesn't infect anybody else.

00:11:49: So basically it worked out well with diagnostics and yeah, we're at a good place right now in terms of detecting the disease.

00:12:00: Vaccine development was also relatively quickly started.

00:12:04: The first vaccine was tested and failed in nineteen eighty seven .The problem here is you can make vaccines that induce immune responses to HIV including the envelope, the spike protein but The virus mutates so much and escapes these vaccine responses rapidly.

00:12:21: And you have to get rid of all the viruses, basically when your body initially encounters it because even if just a few copies make it integrate themselves into yourselves... You know?

00:12:35: ...you're infected!

00:12:36: Then the vaccine doesn't really help that much anymore.

00:12:40: So you need a strong neutralizing antibody response that covers a lot of breath in terms of virus diversity, but also prevents the virus from just coming and affecting a few cells because it's already enough to start an infection.

00:12:59: It is relatively tough to make these vaccines.

00:13:02: many have been tested.

00:13:03: there are lots of work going into this field still very active But today no vaccine would protect humans from HIV.

00:13:13: What should be noted?

00:13:14: there was even a trial, the STAP trial where in phase two B vaccination seemed to slightly increase risk of vaccinated individuals for getting HIV.

00:13:25: This vaccine is based on adenov five-vector vaccine and I think that about this out here maybe they had no five vector activated CD four D cells.

00:13:37: then it became more susceptible to infection with HIV but i don't think numbers are big enough to really draw conclusions, and this is I think just a hypothesis.

00:13:48: But what did happen was that people started to really in detail analyze immune responses through HIV in humans who were infected or who are infected?

00:13:58: And In some cases People can make these what we call broadly neutralizing antibodies so antibodies that neutralize a wide variety of isolates which user usually not the case and also deal with changes of the virus.

00:14:14: So even if the virus mutates, these antibodies can still neutralize.

00:14:19: These antibodies are rare And my understanding is that even people who have them might not have high enough levels to get rid off the virus.

00:14:27: But of course this antibodies can be studied The properties can be started Then that can inform vaccine development.

00:14:34: And so I turned out That many of these antibodies need To go through a lot of affinity maturation Meaning that B cells needs to encounter.

00:14:41: The B-cells that make the antibody need to encounter the virus several times, often many times.

00:14:48: To mutate the antibody genes enough that their resulting antibody is broadly neutralizing.

00:14:55: and what's happening right now?

00:14:57: there are a lot of development in the field of antigen design.

00:15:03: so basically the design of the vaccine itself.

00:15:07: most of these vaccines based on the envelope, the spike protein that are in development and initially it was really hard to make this protein, the right form.

00:15:18: Initially wasn't even known how exactly looks like.

00:15:21: I think there is now a pretty good idea.

00:15:24: And so the antigen got better So the vaccines get better.

00:15:27: The other ideas... This is something actively tested in clinical trials Right Now Is to give multiple exposures or to gift that vaccine multiple times on small doses either by multiple injections over a long period of time, or using systems where the vaccine is released in-the-body very slowly for longer periods.

00:15:50: The idea here to mimic this long term exposure of B cells through the virus.

00:15:57: so maybe that's going to work again.

00:15:59: right now we don't have a vaccine against HIV but you never know and there might be breakthroughs with these technologies.

00:16:10: really great and a really great help in terms of cutting down virus transmission globally.

00:16:17: What I wanted to point out here is the differences to SARS-CoV-II, so with SARS-Cov-II you know new virus emerged started to spread into population And then people start making vaccines With many different technologies.

00:16:32: All their vaccines basically worked.

00:16:35: There's a ton of different vaccine platforms, different types of vaccines that were licensed for SARS-CoV-II and all of them seem to work.

00:16:42: Some better some not as good as other ones but all have worked relatively well.

00:16:49: For HIV it is the other way around The last forty years.

00:16:52: people are trying everything And nothing works right?

00:16:57: I think its just important point out how lucky we where with SARS-COV-I tool in respect of vaccine development that a lot of things worked, right?

00:17:06: It could have been as situation with HIV where after forty years we still don't have working vaccine.

00:17:11: So not every virus is an easy target for vaccines and it brings me to the next topic which is treatments on prophylaxis.

00:17:19: And here they are doing much better.

00:17:22: there has so much development.

00:17:25: There's just fantastic.

00:17:29: Let me start out with the concept here.

00:17:31: When you develop antivirals, so viral medication that targets viruses... ...you typically target parts of the virus that are unique right?

00:17:41: There's many viral proteins or mechanisms that have similar counterparts in cells.

00:17:47: You don't want to target there because they would also basically target our cells as well, you want to look for mechanisms that are unique to the virus and HIV has a number of them.

00:17:59: And I'll walk through these mechanisms in this part or this parts of life cycle of the virus that they're unique for.

00:18:07: the virus is not shared with cells.

00:18:11: one of them was the target off the first truck.

00:18:13: it was developed against HIV.

00:18:16: so HIV has this reverse transcriptase, right?

00:18:19: So it has these unique features where you can make DNA out of RNA and then this DNA is later on inserted into our genome.

00:18:28: That's why it's a retrovirus but that's an enzyme in the reverse transcriptases which are unique to the virus.

00:18:37: The first antiviral was targeted towards those reversed transcriptases Dimitin, or ACT.

00:18:49: That's an interval that in some cases is still in use and that was the first treatment for HIV-AIDS and it was used first licensed in nineteen eighty seven.

00:19:01: And what this does basically looks like nucleotide.

00:19:06: then when reverse transcriptase makes DNA out of RNA basically this long chain, this DNA-chain that the polymerase tries to... or this reverse transcriptase tries make breaks off.

00:19:21: And of course it inhibits the virus process where the virus makes DNA and then integrates its genome into our cells.

00:19:30: So ACD certainly is capable of inhibiting HIV and HIV replication in a long run but It's just one track with one target and the virus mutates a lot, right?

00:19:44: And it turned out that in humans... ...the truck could slow down virus replication but he couldn't stop it.

00:19:52: The virus mutated.

00:19:53: then while there was delay of disease onset people still developed AIDS even if they were on ACT.

00:20:01: So this was in nineteen eighty seven.

00:20:04: In nineteen ninety six The first highly active antiretroviral therapy was brought to the market, abbreviated as HAA-RD or hard.

00:20:19: And what's done here is this a combination of drugs.

00:20:22: I think the first one was a combination two reverse transcriptase inhibitors and one protease inhibitor.

00:20:29: but basically these combinations makes it much harder for the virus to escape mutate it hits the virus much harder and that combination of drugs was much better at suppressing HIV replication.

00:20:45: And so a lot of these drugs have now been developed, they target different parts of the virus.

00:20:51: So I'm just going to walk you through the targets.

00:20:55: One target is viral entry.

00:20:57: So when the virus enters, it binds to cells and the receptor right?

00:21:02: We know CD-IV is one receptor but then there's also the CCR-V receptor and CXCR-IV.

00:21:09: And so one drug has been developed that called Maravi-ROC that targets this interaction between the spike, the anglobe... ...and a CCR V receptor which can basically block infection of cells.

00:21:25: Of course, we discussed last time that HIV can also use CXCR-IV as a receptor instead of CCR-V.

00:21:33: Maravi rock doesn't prevent it but there are other classes of entry inhibitors to actually block that interaction.

00:21:40: so entry inhibitor is one important component of HIV therapeutics.

00:21:47: We already talked about the reverse transcriptase inhibitors.

00:21:51: ACT's One of them But There Is A Whole Generation that also work really well.

00:21:57: Then we have these other enzymes, this integrase right?

00:22:00: So once the reverse transcriptase makes the DNA it needs to be integrated in our genome and enzyme called integrase does that.

00:22:08: And that can also be inhibited.

00:22:10: so We have inhibitors against that as well... ...and then a broadcase is needed To mature the virus particle.

00:22:17: if The broad case doesn't work than the cells.

00:22:21: infected cells produce virus particles but they are non-infectious And so broad days.

00:22:25: inhibitors also work to inhibit virus replication, or various propagation.

00:22:31: Then in addition that we now have capsid inhibitors and then AcapaVir is one of them.

00:22:37: That's the most famous one The one really released quite a bit these days.

00:22:42: So basically it has many different classes with many combinations.

00:22:47: When people started using this combination they are able to treat HIV.

00:22:52: Typically, people had to take a number of bills per day.

00:22:55: It was pretty cumbersome to keep track off all that.

00:22:59: now the manufacturers have started to collaborate and basically treatments were as little as one bill per days needed has been developed.

00:23:11: That makes it much easier to take these drugs reliably And also make them easy for control.

00:23:18: virus replication point or the goal of all this is it's not possible to get rid off virus that's dormant, right?

00:23:27: When you have the virus genome in our genome integrated.

00:23:31: You can't get rid of that because if the virus doesn't replicate... ...you can inhibit it.

00:23:35: but you can inhibit active virus replication and The-the go here is To keep the virus down to less than fifty-fifty copies per milliliter blood And If your down at level basically really suppress virus replication.

00:23:51: So that's just the copy numbers, they are somewhere there in our cells.

00:23:56: and The point here is also if the copy number is dead low Typically you can't transmit the virus anymore to sexual partners.

00:24:07: And That Is Also Important Because If The Virus Is Basically Undetectable In Your Blood Even Though You Still Infected You Can Spread It And that's great for your partner, of course.

00:24:19: But it is also great in general because the virus just can't be spread which means infection cannot be given to anybody else right?

00:24:28: So this works now.

00:24:30: many people these therapeutics really work well.

00:24:33: HIV replication suppressed These people never progress through AIDS and basically we went from a situation where HIV infection was death sentence In the nineteen eighties, those situations were basically with well-managed HIV you have a relatively normal life.

00:24:55: There can be side effects of some of these drugs that can even be with a well controlled HIV infection.

00:25:01: there could be long term immunological issues but in general people will have a relative normal life if they are infected and well managed.

00:25:14: There's often the issue that HIV positive mothers pass on the virus to their babies.

00:25:23: This can happen through placenta, this can happen during birth and breastfeeding but again with these anti-retroviral drugs it is now possible basically minimize that risk.

00:25:39: So in most cases, if it's known the mom is are they expecting mom is infected or even somebody who has HIV positive and wants to have children.

00:25:50: this can be very well managed at their risk of spread through baby can be minimized a very low level.

00:25:57: so thats great news!

00:25:59: And...so basically you look at resource rich countries Europe many Asian countries, North America.

00:26:11: HIV infections can be managed super well right?

00:26:15: The problem is that these therapeutics are not available everywhere and not available to everybody.

00:26:22: And so there's other countries that have less in terms of resources.

00:26:26: they have less well-established healthcare systems where there still progression through AIDS whereas there're a lot spread but... even in high-income countries there is still spread, but hypothetically this can be well controlled.

00:26:41: In many countries it is well control and again this allows a very high quality of life for people who are infected with HIV.

00:26:50: so that's the third beautics!

00:26:51: But there's also lot development in terms of prophylactics That often the same drugs given ahead time.

00:26:59: So since now since two thousand twelve something called Briggs-Boscher prophylaxis.

00:27:05: basically if somebody engages in high risk behavior, for example high-risk sexual behaviour they can take this medication.

00:27:14: If the might have contacts with someone who is uncontrolled HIV They are still protected because there on this truck and it won't get infected.

00:27:25: so this is a pre-exposure prophylaxis also very important tool to cut down on virus spread of the community And this has to be taken ahead of time, but there is now another tool that was developed recently or was licensed.

00:27:42: Or it was shown... ...to work relatively recently.

00:27:48: and then a cup of beer which can be given as injection….

00:27:54: …and have very long half-life for six months.

00:27:57: so basically you get an injection every six month and that prevents HIV infections.

00:28:02: The trials conducted with the drug were super promising, I think they're close to a hundred percent efficacy.

00:28:10: so this is again something specifically in an environment where you might not be able to take brain exposure prophylaxis on a regular basis if you have too.

00:28:21: This could be some thing.

00:28:22: there's game changer If just need injection twice per year.

00:28:27: So Again Fantastic development in terms of therapeutics, it just changed so much.

00:28:36: The problem is only that you need to be in an area or location where these things are available for you.

00:28:43: If they're not available the virus still a huge issue.

00:28:48: None of this treatment actually cure HIV So its'n't like with HCV.

00:28:53: We had episode about that right?

00:28:54: Where there's no cure where you can get rid of the virus, that's not the case for HIV.

00:29:00: But there are a handful of cases were HIV was cured or eliminated from it person and thats possible.

00:29:07: but its not something to just do with somebody who has HIV because this comes in lot of risks too.

00:29:13: And so first known case when this is done was in two thousand seven.

00:29:19: patient named Timothy Ray Brown got a bone marrow transplant Because he had leukemia.

00:29:27: This happened in Germany and he was HIV infected.

00:29:32: And so, he got his bone marrow transplant.

00:29:34: basically what happens is the immune system is wiped out... ...and then you get this transplant!

00:29:39: In a way it can imagine that the immune systems grows back from that transplant right?

00:29:43: It's not your own immune system but its compatible immune system for somebody else.

00:29:54: this famous CCR-V Delta-XXII deletion in his CCR V gene, and he was homozygous for that.

00:30:03: So basically the donor was resistant to HIV.

00:30:08: And now we have a situation where somebody with HIV gets treated.

00:30:11: Basically all his CD-IV cells All of these cells could carry HIV are removed.

00:30:17: Then they get this new immune system from someone who cannot even be infected.

00:30:24: that led to complete eradication of HIV from the body, and this person is known as the Berlin patient because it was done in Berlin.

00:30:37: And since then a handful other people were cured as well... ...because of the same procedure.

00:30:44: you could do that hypothetically with anybody who has HIV but the problem comes when there's a lot risk.

00:30:52: basically your own immune system is eliminated and then replaced by somebody else's immune system, it extremely risky because during that time you could die of very harmless infections.

00:31:07: And so this is not done for regular HIV infected people even though it could hypothetically be done but if The impact on your life is relatively small and you're not going to die of AIDS.

00:31:27: This isn't something that's considered because the risk for treatment would be way too high.

00:31:33: Okay, so just a little summary of current situation.

00:31:38: I think the estimates are about ninety million people have been so far globally infected with HIV.

00:31:46: Approximately four million of them have died to AIDS or HIV-related complications.

00:31:53: And as I said, the situation is improving.

00:31:56: maybe not right now but in the last few years it was certainly improving.

00:32:02: But there's still a lot of areas.

00:32:04: where were their issues?

00:32:06: Just a few global numbers.

00:32:07: i think they estimate that about zero point seven percent Of the global adult population is positive for HIV.

00:32:16: when I say global adult population, i think that was defined there as fifteen to forty nine in terms of the age range.

00:32:23: So thats globally if you look at Africa and African continent its higher.

00:32:29: it's three point four percent.

00:32:31: so you find HIV infections globally.

00:32:33: but specifically the prevalence is much higher.

00:32:37: And then there are certain countries with super high prevalences, some of them even above twenty-five percent.

00:32:43: so more than a quarter of adult population is infected.

00:32:46: in some countries.

00:32:48: I think the highest one is.

00:32:49: Eswatini was twenty eight percent.

00:32:52: HIV infected adults.

00:32:55: In Botswana it's twenty three percent.

00:32:57: I think Lesotho has twenty six percent.

00:32:59: Zimbabwe has twenty three per cent.

00:33:02: So they all pretty high.

00:33:03: South Africa It's a little bit lower.

00:33:06: About fourteen percent, but South Africa is pretty big country compared to the other countries that I just mentioned.

00:33:13: so they have large population of HIV-infected individuals in Africa.

00:33:18: and then in Nigeria it's even low.

00:33:20: A little above two per cent.

00:33:23: But again, Nigeria has huge populations for a lot people infected with HIV.

00:33:30: And then we also have countries outside of Africa that have higher rates.

00:33:34: Belize in Central America is one of them, they have about a three percent positivity rate.

00:33:40: Haiti has two point to Jamaica's are so relatively high with one point six.

00:33:46: Surprising to me was that Russia is relatively highly.

00:33:49: have one point five-one point five percent positivity for HIV which again this quite high.

00:33:59: Thailand has one point three and the Bahamas have one point four, so that's also relatively high.

00:34:05: You can compare it to the US which is about zero point four percent or substantially lower.

00:34:12: And then if you go into European countries Germany for example is your point twenty five percent?

00:34:18: Then there are some European countries that are even lower.

00:34:21: So It really depends on where you are unfortunately, how good the health care system is.

00:34:27: How easily therapeutics available and so on.

00:34:31: it also has to do with living situations With information that your getting was kind of freedom to determine if you have protected sex or not which in some cases a huge issue.

00:34:45: So there's alot factors but I think One can say that the situation has been improving quite a bit in the last few years.

00:34:55: The problem we have right now is, US spending a lot of money through USAID and other mechanisms to improve this situation not just for the

00:35:09: U.S.,

00:35:10: but many different countries in the global south with fewer resources.

00:35:19: And now the US government decided to stop that.

00:35:23: So, U.S.

00:35:24: aid basically got defunded.

00:35:26: a lot of other funds That usually went into Sub-Saharan African countries for example Got stopped.

00:35:33: this is not just an issue For HIV.

00:35:36: we also see issues right Now with Ebola and response to Ebola.

00:35:41: But UN AIDS which Is basically branch Of the UN deals with AIDS estimates that because of these cuts there's likely going to be approximately six point six million more HIV infections and potentially also about four million more H.A.V related or AIDS-related deaths in the future, so we'll see how this turns out.

00:36:04: if other countries can step up and fund some of these things?

00:36:08: If the U.S changes course at some points.

00:36:11: but you can imagine But again, the hope is that other countries step up and supplement some of this or that

00:36:22: U.S.'s

00:36:22: changing course at some point because if you have really high HIV rates a lot people keep transmitting their virus in your country with higher rates than AIDS.

00:36:33: it also destabilizes the company.

00:36:35: It's not just suffering for individuals but its huge issue for countries themselves And so hopefully The situation will improve again in the near future.

00:36:51: So that's it for today, just to summarize HIV used to be a deadly and untreatable infection in the nineteen eighties That basically led to AIDS into death In everybody infected.

00:37:07: now It has become a manageable disease that allows people have regular life And basically regular lifespan.

00:37:14: in resource-rich countries, it's still a big issue.

00:37:17: In countries with less resources and we'll see what the future brings in terms of trajectory.

00:37:25: they have been tremendous developments, tremendous successes with therapeutics and prophylactics as well as diagnostics.

00:37:33: Of course their success for vaccines is something that you're still waiting For but even there There was so much development And so there are So many new data so many new insights that I remain hopeful, in the future there will be a vaccine against HIV as well.

00:37:53: That's it for today!

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00:38:08: Thanks For Listening In And Until Next Time Bye.

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