Speaker 0 00:00:00 KPI
Speaker 2 00:01:00 And good evening. Thank you for joining disability and progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam I'm. The host of the show. Charlene doll is my research team and I'm the engineer tonight. Whoo. I'm actually back in the studio as that permits. That is always good tonight. We're speaking about HIV and the research, the research that's going on, Dr. Tim Shakar is vice Dean of research at the university of Minnesota medical school and lead author on the HIV study. We're going to be talking about good evening, Dr. Shocker,
Speaker 3 00:01:39 But it's good to be here.
Speaker 2 00:01:41 Excellent. Thank you so much for coming on. I really appreciate that. Uh, let's see. So first of all, I'm trying to make sure I have you on, okay. Talk a little bit about how you got into, um, this particular, you know, what your background is as far as, and how you chose this particular branch of medicine.
Speaker 3 00:02:05 Oh, sure. Um, so way back when, when I was a medical student, um, I distinctly remember sitting in the student lounge and reading, uh, an issue of the journal of the American medical association. And there was the description of the first, um, uh, people in, I believe it was Los Angeles with an unusual form of cancer called Kaposi sarcoma. Uh, and they were the only thing that they had in common is that they were all gay men. Um, and then shortly after that came the, um, news of a New York city with the, uh, pneumocystis with the unusual form of pneumonia. Uh, and so I, it, it just caught my attention. I have always been interested in infectious diseases, microbiology, uh, and as I progressed through residency, it's just the one thing that kept coming back to me as being of the most interest. Um, and so when it came time to choose a specialty or a sub-specialty, uh, I chose infectious disease and I wanted to go to a place where I could learn as much as possible about human biology and, uh, HIV. So I went to Seattle university of Washington in Seattle.
Speaker 2 00:03:19 Ah, excellent. Well, I started growing up in, in Washington state. So beautiful place. Uh, talk a bit about what is HIV, I think, um, you know, if you were around in the eighties, you heard about it a lot. Um, and now you don't hear so much. So what does HIV mean?
Speaker 3 00:03:40 HIV human, Amanda deficiency virus is an infection. Um, it's a, it's a particular turn to virus, just like the cause of, uh, of COVID-19 is a Corona virus called SARS cov two, HIV is a retrovirus, so it belongs to a different family of viruses and, um, it is transmitted fairly easily through contact with infected, um, fluids, body fluids. And so it's, it's a sexually transmitted infection. Uh, it can be transmitted through transfusions. It can be, um, uh, you know, th that's the, the main way that it's, that it's passed it, its descendant from, uh, another virus called similar immunodeficiency virus, um, which is an infection in, um, rhesus macaques, or it's an infection in monkeys.
Speaker 3 00:04:38 And, um, so HIV is a covered cousin of SIV and as the descendant actually of SIV. And it's thought that the, the, the jump from, um, monkeys to humans occurred in, um, Subsaharan Africa, probably in about the 1930s. And there's pretty good evidence now to show that that's about the timeline. And, um, it, it was known during the fifties and sixties, it was known in Sub-Saharan Africa as Slims disease. Um, and what it does is it, um, because of the, the unique cell that it infects the, you know, viruses have to infect cells to survive. Um, it infects a particular cell in your immune system, uh, and destroys that cell as a, as a, um, function. Um, and that that's what causes the, um, the, the symptoms and the disease. We now call aids the acquired immune deficiency syndrome. And the way that I talk to patients about it is when they get infected, it, it, you know, the, the salvage, it gets infected, it's called the CD four T-cell or the C the T helper cell.
Speaker 3 00:05:51 And that's the cell that is like the orchestra conductor of your immune system. It really is what keeps the outside world out. It's what controls your second skin. And as those cells go away, horns appear in that second skin and in unusual infections and cancer has come, come take over. And that's, that's really what happens in, in HIV infection. So it really didn't come to our attention until it got into a particular population. And in this case, a mother have sex with men, um, and, um, the, the, it, it, it, it was amplified for whatever reason. It was amplified in that population. And this came to light in the eighties, um, and, um, uh, in the early eighties, and, um, as, as the, um, the understanding of the infection grew, people started to put together the, you know, connect the dots sort of thing, um, to understand that, you know, people who got transfusions, for example, and in that time, it was haemophiliacs who got a lot of transfusions, and they became, uh, a segment of the population that, that had HIV.
Speaker 3 00:07:07 Um, and then it, it, you know, the dots were connected again to, um, uh, slim, uh, Slims disease in Sub-Saharan Africa. And, um, you know, the story unfolded so that by the early nineties, we had a reasonably good idea of, of what this infection was, how it was, how it is transmitted. Um, and that began the, the real search for, you know, how does this disease cause the condition we know as aids. Um, and of course, once we understood that, um, it, it became more clear how to develop drugs to combat it. Uh, and, and that began the, you know, the industry that we know as the, uh, anti-retroviral drug industry or the, the drugs that we use to treat people with HIV are living with HIV. And, um, uh, now today, um, you know, most of my patients are on one pill once a day. Each of those pills contains three different drugs, three or four different products, but back in the early nineties, you know, uh, and, and mid nineties, we were prescribing regimens where, um, folks living with HIV were taking 24 to 32 pills a day.
Speaker 2 00:08:27 That's amazing six
Speaker 3 00:08:28 Hour interval.
Speaker 2 00:08:28 We'll get to more of that treatment. I'm curious to know, like, you know, I always heard about needle sharing and, and that's one of the things that I always, my understanding was that that was a cause too. How big is that a problem in the HIV?
Speaker 3 00:08:50 So, um, uh, needle sharing is, um, a significant form or is a significant cause of transmission of HIV, especially in, um, uh, in, in, in it, it is a significant, uh, it is a significant cause of HIV transmission. And so, um, uh, it, it, isn't a mystery, you know, th th the, the syringes get contaminated with blood, and if they contain blood with HIV, then you're injecting it into the next person. Right.
Speaker 2 00:09:26 Can we talk about symptoms? Um, what are symptoms of HIV?
Speaker 3 00:09:32 So when the untreaded individual, we think about the normal, probably three or four, well, three different ways during the acute stage, when you first get infected, it's very much like, um, Marto, you know, the patients will tell you what's the, it's the sickest they've ever felt in their life, but it's symptoms of mononucleosis. So it's big swollen, lymph nodes, it's high spiking, fevers, um, uh, it's, you know, those kinds of things. Uh, and those last, those symptoms last, you know, probably up to 14 days, and then they resolve and the patient at that point, the person living with HIV at that point enters what's called the chronic phase. So they go from acute to chronic and in the early chronic, uh, stage of the disease or the infection, um, it's, it's, you know, they might get a few more codes, they might get, um, uh, chick and, you know, uh, shingles, for example, um, and that sort of thing in certain parts of the world where TB tuberculosis is, is, um, much more, um, common, prevalent.
Speaker 3 00:10:39 Um, they might reactivate tuberculosis. Um, if they have herpes simplex either, um, in the lips or on the, in the genital region, those might reactivate the cold sores, for example, it might reactivate more often. Um, so it's, it's pretty common, manageable, uh, sorts of infections. And it's mostly infections as the disease progresses as the infection progresses. And, uh, the CD four T-cell count that second skin fades even more, um, more complicated problems emerge. So, um, thrush, for example, um, a yeast infection in your throat, it would be pretty common, um, more severe herpes in the early days. You know, we saw it, wasn't unusual to see people with drug resistant, uh, herpes infections and that kind of thing. But once your CD four count gets below a certain level, that's pretty low. Um, that's what we call clinical aids, and that's where the, the opportunistic infections and malignancies occur. And so this is a, uh, a well-defined set of, uh, diseases and infections, um, uh, in your CD four account has to be pretty low at that point. And so, um, those are things like pneumocystis, pneumonia, uh, certain infections that affect your brain, um, cancers, um, are, are a part of this. So lymphomas and that kind of thing. Um, and eventually, you know, the person, usually, if, if they're not treated, uh, will die of one of these opportunistic infections or malignancies,
Speaker 2 00:12:25 I'm wondering, um, it seems like people would make go through this in different paces. Like it, they, it wouldn't, it wouldn't make people necessarily ill the same pace of time. So when did you guys usually see somebody coming in at what point? I mean, I'm sure there's all different points, but how would one know to go get checked for that?
Speaker 3 00:12:56 So in the early days when we didn't have antiretrovirals, um, it was more common to see people coming in when they had very advanced disease, um, in university clinics where often there was a lot of research going on, um, uh, patients were, or people living with HIV were typically identified a little bit earlier. Um, but, um, now today, um, it's much more common to diagnose somebody with really early, um, HIV infection. So I could just cause people are more aware, and they're also aware that if they start therapy, that they should be starting therapy as quickly as possible. So now people who come in who are diagnosed, typically their CD four count is much higher. They really haven't had much of a problem and we start them on anti-retrovirals. And that, that typically stops the, um, the progression of the disease.
Speaker 2 00:13:55 We need to take a short station break, and I want to remind everyone that this is pledged night. Please feel free to call 6 1 2 3 7 5 9 0 3 0. Also go on the
[email protected] is safe and secure. Give what you can, this show runs by you, and, uh, we depend on your support. So please, please give Dr. Shakar. I wonder if, you know, I'm going to skip back to when we were really hearing a lot about this in the eighties and the nineties, and, um, the statistics seem astronomically high, um, but now you've really don't hear as much anymore. Have the statistics really changed or is it just that you don't hear as much about it anymore?
Speaker 3 00:14:46 It depends on where in the world you live. Um, uh, we will need acknowledge that in the United States, there's still about 36, 30 7,000 infections per year. Um, but if you, if you just step back and say, you know, worldwide, what, what has happened and is happening, um, it overall there have been 80 million people infected with HIV. 36 million of those people have already died. That means 38 million people are living with HIV. And most of those people are living in places where resources are really constrained if you go to, um, cause we were going to trial in, in, um, uh, South Africa, you know, it's one in three or one in four women are HIV infected. Um, and that statistic hasn't changed and really what that is, is access to healthcare and access to antiretrovirals. You know, now a few years ago it was appalling, uh, uh, how few people worldwide had access to antiretrovirals.
Speaker 3 00:15:54 That's changed significantly in the last five to 10 years. I think the current statistic is that up. I think 40%, if you go outside of Europe, the United States, probably 40% of people have access or are on antiretrovirals, but we have a long way to go. And so what you're seeing is that the number of people living with HIV is going up and they're living longer, um, because they're on antiretrovirals, but there's still large portions of the world, particularly Sub-Saharan Africa, South Africa, um, where this is just a huge, huge problem. And then there's other parts of the world where we really don't know, um, uh, what, what is happening? Parts of Asia, central Asia, Russia. Um, it's, it's really not clear what the status of the infection is in those parts of the world.
Speaker 2 00:16:50 So what I hear you saying is that the numbers are still going up, but that there's more ability to care for these numbers.
Speaker 3 00:17:01 We're actually not going up that on, but there's still a significant number of people infected
Speaker 2 00:17:08 Every year. Yeah. Yeah. And is there a race and or gender preference that this tends to be higher in?
Speaker 3 00:17:18 Yes. Um, and so I haven't, I can give you good numbers for the United States. It's probably very similar. And in Europe, um, in that, um, you know, close to half of new infections every year, 45% are in, um, uh, uh, people who are black or African-American. Um, so if you just look at it as, you know, Caucasian versus not Caucasian, 24% are Caucasian and 77% or not, or 76% or not. Um, the, um, in the United States, 20% of all new infections are in women. Um, and that's, that's a mix of injection drug use or a partner of somebody who's an injection drug user, um, most commonly. And then if you look at the age, this is, this is I think, um, still something that, that is, um, doesn't get as much attention as it should. Almost 70% of new infections in the United States are in people who are less than 40 years old and, um, 30%, 36%, well, 30, 35 to 40% of those people are in their twenties. So it, it is a, uh, infection of young people. And that, that is, you know, it's, it, it, it, there, there are, there are public health measures that work, there are medical interventions that work at prevention. And so I just, I think we need to do a better job of, of getting that message out there to protect our young people.
Speaker 2 00:18:52 I was going to ask, I was like, you know, this isn't, unless you're HIV is something that is heard of, and you would think that people would understand the police, some of the things you'd need to do. Is it just purely you think educational that is going on? Or is it cultural? What, what is happening that people are not?
Speaker 3 00:19:16 Yeah, I think it's all of the above. Um, you know, the, um, one of the striking differences between, um, COVID and HIV in terms of the, the, the, the response to the infection. Um, this has been true since the very beginning of the HIV epidemic or pandemic, and it is that the older folks in the community. So in, if, if, if it's the men who have sex with men in community, the older folks really become the teachers of the younger folks and, and, and guide them into how not to get infected. And you don't see that you don't see that kind of, of wanting to help one another, uh, as much in, in COVID. So, um, you know, th th it is, it is an education gap, but it's also a, um, uh, access to care gap. I mean, a lot of these kids are homeless.
Speaker 3 00:20:15 A lot of these kids are experimenting with injection drugs. Um, a lot of these kids are, um, you know, struggling with gender identity and, um, and I don't think we're helping them very well. And so, you know, we've got, um, you know, just witness what's happening in Florida. We've, we've got pre-exposure prophylaxis that, that works and works well at preventing infection. We've got post-exposure prophylaxis that, that works and works well to prevent. We know about the, um, just like we know that that masks work for COVID condoms work for a transmission of HIV access to clean needles works for preventing transmission of HIV. We've got a lot of tools in that toolkit. Um, it's just number one, having the ability to use them, getting the word out and, you know, giving, giving these folks access to those tools.
Speaker 2 00:21:14 I do want to let listeners know if they just stumbled on, and I probably should've said this at the beginning. This may be a sensitive topic to some people. So, um, uh, guide yourself in what you feel you may want young ears to hear. Um, this is cafe 90.3 FM Minneapolis and cafe.org. This is pledge drive. So you may visit
[email protected] or call 6 1 2 3 7 5 9 0 3 0. And we're speaking with Dr. Shakar, who's talking about HIV in this studies, Dr. Schacher. I wonder, um, I always hear it HIV and aids, so I know there must be a difference, and I think I get confused with a different, so can you lay it out a little better, but for, you know, um, the lay people that hear that in conjunctions, what is the differences between the two?
Speaker 3 00:22:10 So HRV is the virus that you get infected with aids is the clinical syndrome that's caused by the infection, just like SARS, cov two is the infection is the virus that you get infected with COVID are the symptoms that you get as a result of SARS, cov, two infection. So it's the same, same difference. So HIV is a virus you get infected with. It causes damage to your immune system, you get aids, and that's the clinical, it's a clinical definition.
Speaker 2 00:22:45 So let's talk longevity. I think that, you know, when you were talking about, when you guys kind of first started out, or, you know, 20 whatever, 30 years ago, that when you were, when people were taking 20 or, you know, several doses of medication, they did not, you, you often heard about people dying quite young from this, but it's clear that the longevity part, that people are living longer, much longer, actually, it seems, um, how to give us some insight onto that
Speaker 3 00:23:22 Yeah. In the pre antiretroviral area. And so in the era, before we had any drugs, um, the natural history studies that were done showed that on average people from the time that they got infected until they died of the disease was somewhere in the seven to 10 year range, probably closer to seven years. Um, and that can vary a lot. We know that there are people who get infected and have almost a normal lifespan without any drug intervention at all, the longer term non progressors. And we've got people who get infected and I, within six to nine months, the so-called rapid progressors. Those are very few, most people. It was in that seven to 10 year range as we get into the era in the nineties where we had drugs, that weren't very effective. Um, you know, that, that stretched out a little bit longer.
Speaker 3 00:24:23 And now in today's era where we've got, what I think are probably pretty effective drugs at suppressing the virus. Um, you know, we're saying that that people are going to have normal lifespans probably, but they're going to have close to normal lifespans. Um, and so we've still got work to do, but if, if you just look at what has been accomplished, um, especially in, in, when we're talking about an infectious disease like HIV, and the fact that, you know, you've you, the target that you're, you're looking at, um, you know, we have, well over 35 licensed anti-retrovirals now, and that's all been done just in the, the, you know, in a 20, 25 year period. And that's, that's a remarkable accomplishment. So we've gone from HIV being a death sentence from 98% of people to it being a, you know, manageable chronic condition. Assuming you take your medications for most people who have access to those medications.
Speaker 2 00:25:29 I think when you started out, you know, and the, and the eighties and whatnot, the HIV was very, I was such a taboo or sensitive subject. And if anybody knew somebody who had it, um, it, it was a very alienating, you know, disease. Has that changed now? Or is it, how do, how has that, that treated?
Speaker 3 00:25:56 So, um, it's, you know, it, it, it is talked about much more openly. Um, there are some, you know, some patients that I've worked with over the years, um, have, have had, uh, uh, you know, a really open relationship with their family and they talk about it. But, you know, even today in clinic, I had a young guy who's afraid to tell his parents just because of the stigma, um, associated with HIV infection. And that's, I, I, you know, I don't like using these kinds of words, but it's not uncommon. It's, it's, it's, you know, it's, it's, it's, it's frequent that I have this conversation with people who just got, just got diagnosed with HIV. There's still a stigma. Um, uh, it's not like it was many years ago, but it's still it's out there.
Speaker 2 00:26:45 We need to Nate take another short break, but while we're doing that, I want to encourage you outlet their listeners to go to cafe.org, and please show us your support. We do depend on that to do what we're doing. And we bring in many great guests throughout our year. And I, I hear comments from you on the emails. So please go and donate cafe dot O R G or 6 1 2 3 7 5 9 0 3 0. So Dr. Shakar, I, I, I'm always amazed at what is happening and I'm very happy to see that these studies are progressing because even though I, I, I, I understand. And I, and I actually even fear COVID, uh, all I hear is COVID, COVID COVID, as I'm sure everyone out there is hearing, and it is, um, nice to be able to read the stuff that is happening. That's still going on and, and that not everything is concentrating on that. Um, I just want to talk about the current studies that are happening. Um, the treatments have, as you said, have changed from 30 years ago, and now you're saying it's down to, like you said, one pill a day, But now there's, there's these current studies that I read. And I think, um, if you're going to have to correct me, cause I, I, I think it's three people now that have been cured. Is this what I should understand?
Speaker 2 00:28:25 And what does the term cured mean to you?
Speaker 3 00:28:30 That's a really good question. And one that there's not wide agreement in the field on, um, when we talk about two different forms of cure, one is that there was no evidence that the virus anywhere in the body, and that's a really high bar. The other is that you could take somebody off of their, of their drugs, their inner retrovirals, and there would be no evidence of virus replication in the blood, and there would be no progression of the disease. So there's still in fact that they still have the virus, but, you know, you're able to, to in effect, restore immune function to keep it at bay. Um, and you know, so th th th that's, uh, uh, an important distinction with the three individuals that you're talking about. Most of us believe that they were actually cured, that there was no evidence for the virus in their body, um, after the, the treatments that they had, most of the studies that are going on today that are in the, what we call the cure agenda, they're really looking more at what we call the functional cure, um, you know, training the immune system to, to just totally control virus from replicating, not trying to totally eradicate it.
Speaker 2 00:29:47 So let's go and talk a little bit about, uh, the first two studies where they done it once the two males, I think, right, right. Were they done at the same time?
Speaker 3 00:29:59 No, no. The first, the first patient, um, I can't remember the exact year. Um, but he, he was an individual he's since died. Um, of other causes. He's an individual who, um, uh, was living abroad and, uh, developed a particularly aggressive form of leukemia. That is, um, it is one of those opportunistic movement seas that's known in HIV infection. Um, and so when he had his leukemia, he required not one but two bone marrow transplants. And what they did was, you know, in order to do a bone marrow transplant for leukemia, often they, they do really aggressive things, total body radiation, uh, chemotherapy to get rid of all of the immune cells. Um, and so these are many really, um, toxic, uh, therapies that are life-saving if, if you need them. Um, but they have a pretty high mortality rate and what they did with this first patient, and actually the subsequent patients is that they, um, they utilized, or they took advantage of, of what you could call a chink in the viruses armor.
Speaker 3 00:31:20 Um, they were able to put cells back into the patient that the virus simply couldn't infect. It didn't have the right machinery to infect those cells. And there's a small, it's a very interesting story. It goes back to the plague actually, but there's a small percent of people who have cells that simply can't get HIV. In fact, that, um, uh, so what they did was they, when they did the transplant, they gave him both, both gentlemen, actually, they gave cells that were this modified. I mean, it, they, they were cells that simply couldn't get infected with HIV. And so, um, the cells that we populated and restored their immune system were impervious to the infection and over time, um, any cells that remained, that were infected, they just died. And so that's why I say, we think that, that they were more the actual, the cured of the infection and, um, a lot of studies that were done on these folks. We, we participated in those studies and, um, you know, contributed to the literature that says we just, we can't find it in them.
Speaker 2 00:32:31 Um,
Speaker 3 00:32:35 No, I was just going to say that th th the, the circumstances with third patient with, you know, they're, they're a little bit different, but the, the story is the same transplanted with cells that couldn't get infected.
Speaker 2 00:32:47 So, but the first with the first two with the two males, how far apart were they done?
Speaker 3 00:32:54 Oh, years, um, uh, years.
Speaker 2 00:32:58 So they, they did them. You said approximately the same way where they were, they did, is it like immunotherapy type?
Speaker 3 00:33:08 Well, um, it's chemo, so there's no, it's a good, good question. It's it's chemotherapy it's, um, it is, um, basically just blasting all of the cells of the moon system away so that there's, And then you put new cells in the tech get HIV infected. You're never going to completely get rid of all of the cells. Um, and so you're going to get rid of 99% of them, or some huge proportion and the cells that, that, um, you put back in, and if they can't get infected with HIV, you know, the cells that removed that happened to have a virus, and then they're going to die and they can't spread the infection to other cells.
Speaker 2 00:33:50 So
Speaker 3 00:33:50 Dental therapy is when we train the immune system to be more effective, and that's, that's much more modern than what happened with those folks.
Speaker 2 00:33:58 So did they do anything different between the two?
Speaker 3 00:34:03 Well, not effectively. I mean, the, the, you know, there, there were differences in the amount of, um, chemo that were used and that sort of thing, but, but the, the strategy is the same.
Speaker 2 00:34:14 And what were the side effects? There must have been some side effects with this.
Speaker 3 00:34:18 Oh gosh. Um, I, you know, so I'm not a transplant, um, uh, physician, but I've taken care of a lot of the infectious disease complications of transplant. Um, you know, you're, you're basically taking away their immune system and you're, you're blasting them with, with radiation, um, uh, and chemotherapy. And so you're th th there's all kinds of potential for infections to, to, um, take hold for, um, the immune system, as it recovers to really rebel against the immune system, you're trying to put in them. Um, and that causes a host of problems. That's why I say, you know, this is not something that's exploitable. This is not something that we would just recommend for anybody. This is only if you have a really aggressive cancer, that's going to kill you. Uh, would we recommend this approach to, um, curing HIV, but, but what it shows in principle is that this can be done. And if you take apart all the components of what is done, you know, you eliminate the reservoir, you put cells back in the can't be infected. You, you know, you support that person. You know, th there, there are probably ways we haven't come up with them yet, but there are probably ways to duplicate that that are far less toxic. Um, but that's, that's, I think where the field is at right now,
Speaker 2 00:35:43 And you both, the males are deceased.
Speaker 3 00:35:47 Uh, I didn't even hear about the first one. I'm not certain about the second one
Speaker 2 00:35:51 And were they both done because they had cancer and they needed it to, I see. Okay. So it was almost maybe an accident that they discovered.
Speaker 3 00:36:00 No, no. It was 10 in both of those patients. It was an intentional, we we've known for some time that there are these cells in a certain proportion of the population that can't get infected with HIV. So there are folks who have been exposed multiple times to HIV, and they've never gotten infected. And it's just, it's a, it's a certain genetic modification on their T cells that the virus just can't land on them. They can't, it can't take hold. And, um, so th th the decision was made when, when it was clear that this person to survive, their cancer was going to need a transplant. They were able to find a donor who matched, you know, matched enough of their immune system. Um, but they had cells that couldn't get infected.
Speaker 2 00:36:46 So the third one was a woman.
Speaker 3 00:36:49 Yes.
Speaker 2 00:36:50 And it was actually done differently. Right. It was
Speaker 3 00:36:56 So I'm, yeah, I'm not real familiar with all the intricacies, but I, it, the, the, the, the theme was the same. She had a cancer that was going to kill her. They were able to put cells back in her that couldn't get infected. They had more modern, um, approaches that did include immunotherapy, but it's still the same. It's getting one of the reservoir, you know, get rid of the immune system. That's in fact that put an immune system back in that can't get reinfected and then support the person.
Speaker 2 00:37:32 My understanding was that she did much better, um, in regards to the side effects because of the, the way the treatment went that time.
Speaker 3 00:37:45 Yeah. So again, I know it's, it's the, um, th th it is the more modern approach, uh, the use of another therapy and that sort of thing. Um, but the, the, you know, the, the, the really important message here is that this is this, this is an approach that really can only be used in people who have malignancies cancers that are gonna kill them. Um, and that, you know, we have access to cells that can't get infected. You know, the, the chemotherapy, the radiation, immunotherapy, those are going to change over time. Uh, it might be a little less toxic, et cetera, but it's still, the idea is still the Sabre.
Speaker 2 00:38:28 So what do you want people to take away from these studies that are coming out
Speaker 3 00:38:38 Well from, you know, really from those three examples, we know that in principle, we know that HIV can be cured. Um, it's just, it's not going to be for very little people because of the inherent toxicities of the world that we have to go about it it's, it's, you know, in people it's three people so far, and, you know, The cells that'll that'll survive and people that can't get infected. That's, that's pretty rare. But, you know, when I said, put themselves back in the can't get infected well, this, some very clever folks realized that they could take CD four cells from people and gene modify them. So they were using
Speaker 2 00:39:20 Genetic
Speaker 3 00:39:21 Manipulation and the movie, the receptor, the removing the part of the cell that the virus needs. Um, so that they're actually mimicking the, you know, what was done in those patients. And now that we're getting into therapy, that's far less toxic, but, you know, can support those cells. There are, there are ways that are being looked at, um, to, you know, gradually increase the proportion of the cells in the body that can't get infected. And as that happens, it, you know, so this is a long ways off, but, but there are humans, you know, we're doing these studies in humans today. So, you know, it's, it's pretty remarkable actually. Um, so, but, so, you know, it's just the point that these three patients have taught the field an enormous amount. They've shown us the path. We now have to figure out how to do it in a way that is non, you know, much, much less toxic, um, and, um, is going to be much safer for the patient because honestly, at least in the rest of the world, you know, folks have access to therapy. That's going to give them an almost normal lifespan. So things that we come up with can be things that, you know, there's a 30% chance that it's going to kill you.
Speaker 2 00:40:38 So it brings me to this topic of gene editing, which presumably the story is that that has already been done. Um, what is the people who are doing the studies feelings on something that could be edited and, and fixed maybe?
Speaker 3 00:41:03 Well, so, um, um, I, you know, I want to be really clear about this. This is, these are very early days, um, gene therapy as a field, you know, w there's only a couple of examples and it's not in HIV where gene therapy has successfully, um, fixed the problem. Um, and so this is, like I said, this is very early days, but, um, uh, you know, if the goal is to eradicate the reservoir of infected cells and replace them with cells that can't get infected, you know, probably the most straightforward way to do that is with genetic engineering of human CD forest house. Um, it's it, the, the rate of, of, um, progress in this research is accelerating. Uh, we're getting much more accepting of the, the way to do these kinds of clinical studies, but it's still really, really very early days.
Speaker 2 00:42:08 I wonder you always hear about things that just, you know, myths with HIV and whatnot that are not true. Are there any that you know of that you can share with listeners that, you know, what kind of help things
Speaker 3 00:42:26 That Mitch
Speaker 2 00:42:27 Misser examples of HIV? Ms. Said things that are not true in regards to it?
Speaker 3 00:42:34 Oh, um, gosh, um, early, early in the, the pandemic, you know, there was lots of misinformation. Um, now I, I don't hear it as much of that. Um, I mean, it could be out there and I just don't know it. Um, but, um, you know, we, we, we know the virus, we know how it's transmitted. I think there's wide acceptance of that. Um, we we've got good therapies for it. Um, you know, I think where the barriers are, if the, if that's part of the question, um, the, the barriers in our country and in Europe are still the, the, the, um, what's the right word, the, you know, the, the feeling that if you've got HIV, somehow that, you know, you, you could have avoided that and you know, that kind of thing, um, in the rest of the world, um, you know, it's, it, it, the experience that I've had and the work that I've done in, in Africa anyway, is that, you know, if you, if you give people the tools, they will use them, they will use them. And, um, but it's just getting that out into the hands of the people that need it. And there's a lot of barriers to that. There's, um, you know, there's a lot of people there's the, the, the information systems are not as good, you know, it's, it's that kind of barrier, but as far as the misinformation, um, in this country, I just don't see it as much as I used to.
Speaker 2 00:44:10 I have my research person that has, that is with us. Charlene. I just want to make sure she didn't have any questions in regards to this topic. So, Charlene,
Speaker 5 00:44:23 I, I really don't. I was working at the VA when the, this whole stuff came around in the eighties and it, it changed the dynamics big time, and now I don't work there anymore, but I'm hearing that now. It's just another thing that happens to people and they treat it and they move on.
Speaker 3 00:44:45 Well, so I want to put a cautionary tale around what, what you said is I think mostly true, uh, when I was a med student, uh, at one of our local hospitals, you know, the, the, the, you know, the, the residents had to be convinced that they should go in to take care of these poor kids, because nobody really knew how it was transmitted. And, um, there was a lot of discrimination as a result of that. And that's, that's, I think much less true if, I mean, I just don't see it as much. I see it a little bit. Um, but this idea that it is, you know, you just, bam, there you are, and we'll take your pills and you move on. Um, I, you know, these pills are not without side effects. Um, these folks do not have a normal immune system. They're still at risk for, um, some challenges and problems. And everyone that I've talked to has said, you know, if I could, if we could cure this or I'd take that in a heartbeat.
Speaker 5 00:45:46 So two people with a, with HIV, do they have a shortened lifespan?
Speaker 3 00:45:52 So the data are, um, evolving on that a, you know, five years ago, uh, I would say absolutely. Um, it's, it is, you know, what we would say as an almost normal lifespan, um, today with the, with the therapies that we've got, I, we just don't know if that's improved things or not. Um, but, uh, the, the data from several from a few years ago were pretty clear that, you know, it, it, it dramatically improved, um, uh, the length of time that, that people could, could live with HIV.
Speaker 2 00:46:29 And when you say almost normal lifespan, are they dying? How a typical HIV person might die from like something that they have gotten because of their immunity? Or is it,
Speaker 3 00:46:43 Yeah, that's, that's kind of the challenge, uh, to that, because there's a couple of things we know about HIV infection in, in people who are treated with today's drugs. Um, HIV is still a, uh, infection that causes this phenomenon of accelerated aging. Um, so the, the frailty index tends to be higher. The, um, you know, the, the, the biochemical studies that are done on some of these folks show that the whatever marker of accelerated aging you want to use, it just seems to be that they are, uh, aging faster. Um, it's also a disease of, of chronic inflammation. So, you know, we know, for example, with, um, people who have heart attacks, sometimes there are, you know, we, we attribute that sometimes to inflammatory conditions,
Speaker 3 00:47:40 And we know that an HIV infection even today, and are well-treated individuals, there's a subset of people who are likely more likely to have blood clots. We're more likely to have heart attacks, and we're still having trouble pursing out who those people are. You know, what are, what are the, what are the markers that say you're at increased risk? We'll, we'll pay more attention to that. But so, you know, when, when folks are, when we say near normal lifespan and they're dying of a heart attack, you know, was that because they were going to have a heart attack anyway, or because they were HIV infected and had this pro-inflammatory condition. So I think, you know, there's a lot of, of, um, really important work. That's going into teasing that out, but you got to step back and say, okay, we're going to do that work.
Speaker 3 00:48:27 But look, you know, we went 30 years ago from a disease that was a death sentence to almost a near normal lifespan. And that's, that's, uh, you know, every, um, a few years, you know, we're making dramatic improvements in that. So, um, there's a whole area of research right now that, you know, we call the HIV cure agenda. And, you know, we think that if we can, um, when people to a functional cure where we can take them off their meds, where their immune system has is enough restored that that's going to control viral replication, that inflammatory conditions are going to go down. We think that's going to be a big improvement, um, in, in how people live their lives,
Speaker 2 00:49:15 Does diet and or exercise play into anything as well as how people deal with the medication that they get and how they, you know, how long they live with the HIV.
Speaker 3 00:49:29 So I I'm, I I'm, I, I believe that diet and exercise are ways improve Disease, outcomes are ways. And, um, and that is true with HIV. Um, you know, th the most effective anti-aging, um, approach that we have. It doesn't matter if you're HIV infected or not is daily exercise. If, if you get good exercise, you're going to slow down the aging process. Th th th those data seem pretty clear. Um, so yes, I think that, that, that there is no question that, that having a, you know, a healthy diet getting regular exercise will, will significantly improve your, your lot on life.
Speaker 5 00:50:15 I have one more question. Can a pregnant woman give the HIV virus to their unborn child?
Speaker 3 00:50:23 Yes.
Speaker 5 00:50:25 Well,
Speaker 2 00:50:26 Are there things that can stop
Speaker 3 00:50:29 That, but that's, you know, th th there's a lot of caveats to that. Some, some don't, um, we've got safe and effective antiretroviral therapy now that we can give to pregnant women. And, you know, there was, there was little to no risk to the fetus for doing that, uh, and that prevents the infection. And we have really well-developed and, uh, effective tools to monitor the baby. Um, after they're born to see if they did acquire the infection, and if they did, then they can be treated. But I have to tell you that the, in the, in, in, in our country, the incidents of vertical transmission, you know, from mom to baby has dramatically gone down. It's where you see it more, obviously it was in parts of the world that just simply don't have access to antiretroviral therapy.
Speaker 2 00:51:18 And so I'm presuming this, so, correct me if I'm wrong. If the mother is on anti, uh, the viral therapy and they've had a child that they would not nurse With, would they pass it that way?
Speaker 3 00:51:36 Yeah, so I, I, you know, I'm, I'm not a pediatrician and, and the science has evolved a lot in the last few years. My understanding of it is yes, you can transmit from nursing and in parts of the world, that is a lifeline for the baby. And so, um, if the mom is on antiretrovirals, the incidence of transmission has promatically decreased. Um, and so, um, uh, but again, I just don't know the, the, the most recent data on that.
Speaker 2 00:52:06 Gotcha. Dr. Shakar, we have to wrap it up and thank you so very much for our, um, endless questioning with this system. It's a great topic and good luck with the research, and I hope you're back on and another handful of years to talk about more new things that are happening with this.
Speaker 3 00:52:25 That sounds great. Thank you very much. I enjoyed
Speaker 2 00:52:27 It. Thank you, sir. This has been disability and progress. Um, the views expressed are not necessarily those of cafe or its board of directors. My name is Sam. I'm the host of this show. Thanks so much for tuning in. This is, uh,
Speaker 2 00:52:45 This is pledge nights, so we are encouraging to go pledge 6 1 2 3 7 5 9 0 3 0 or cafe dot O R G. We have been speaking with Dr. Tim Shakar, Dr. Shakar was the vice Dean of research of the university of Minnesota university of Minnesota medical school. And also the author on the HIV studies that have been happening. This is cafe 90.3 FM, Minneapolis, and kvi.org. If you want to be on our email list, you may email
[email protected]. Charlene doll is my research team, and my name is Sam. I've been the host and producer of the show tonight. Thanks so much for tuning in
