I published the following series of articles in a different forum from November 2005 to December 2005.
Khushboo, Suhasini, Sania Mirza, Safe Sex and AIDS
November 23, 2005
“Society should free itself from outdated thinking that a woman has to be a virgin at the time of her marriage. They should know to protect themselves from pregnancy and AIDS, if they choose to have sex before marriage. Educated men these days do not expect their spouses to be virgins at the time of marriage.” -Khushboo
These comments outraged Tamil Nadu political leaders who burnt Khusboo’s effigies, demanded her to leave the state and filed defamation cases.
''She (Khushboo) was totally misunderstood. It is a disgrace for all of us'' -Suhasini
By supporting Khushboo, 'She (Suhasini) has brought shame to the Tamil people' - according to yesteryears star Manorama, directors Seeman, Keyaar, and V C Guganathan.
"So there are two issues here -- safe sex and sex before marriage. You don't want me to tell you that you have to have safe sex, whether it is before or after marriage. Everyone must know what he or she is doing." -Sania Mirza
Kiran Kumar, organising secretary of RSS in Vijaywada, said young stars like Sania Mirza should behave with dignity in inspiring youngsters. Shouting “Down, down Sania” the ABVP protesters in Visakhapatnam slapped the posters with chappals and then burnt them.
(Since left radical students of JNU took upon the role of teaching foreign policy to the prime minister, the ring wing RSS/ABVP activists took up the role of moral police.)
I will leave it to you to decide if Khushboo, Suhasini or Sania were advocating pre-marital sex. But they are definitely advocating safe sex.
Vast majority of Indians do not indulge in pre-marital sex and extra-marital sex. But many Indians do.
“Some surveys show that one in five men have extra-marital sex while only 25 per cent of these use condoms. Another survey shows that 30 per cent of youth have experimented with pre-marital sex.”
Even if you believe that these surveys over-estimating the number, and only half (about 10%) are involved in pre- or extra-marital sex, that is too many and too deadly for the society with significant number of HIV positive people.
India already has over five million HIV-positive people and 39% of them are women. Also, 80% of HIV positive women have got infected because of their husbands.
Read the story of Nagamani at the Vasavya Mahila Mandali in who was driven out of their house after her husband died of AIDS and she tested HIV-positive.
(http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/south_asia/4260314.stm)
It is an undeniable fact that AIDS epidemic is on the raise in India due to mostly unsafe sex.
UN Millennium Development Goal of halting and reversing the spread of Aids by 2015 will be hard for India to achieve if we do not spread awareness of this deadly disease and its transmission.
In the next posting I will write about this retrovirus and scientific struggles to control and eliminate it.
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HIV infection and AIDS
November 28, 2005
A virus called Human Immunodeficiency Virus (HIV) causes Acquired Immuno Deficiency Syndrome (AIDS).
Symptoms of HIV infection and progression to AIDS:
The important thing to know about HIV and AIDS is that most people newly infected with the HIV virus show almost no symptoms for a few years. But, during this period (without any symptoms), HIV is actively multiplying, infecting, and killing cells in the immune system. People are very infectious during this early phase.
As the immune system weakens, symptoms begin to emerge. Some people, but not all, develop symptoms within a month or two of exposure to HIV. These people may have a flu-like illness.
These early symptoms usually disappear within a week to a month. Most HIV-infected people who experience these early symptoms won't see any more signs of the infection for at least a few years. Usually, it takes about eight to nine years for later symptoms of deteriorating immune system.
Once immune system is weakened in a full-blown AIDS patient, he becomes an easy victim of many opportunistic infections like pneumonia, and dies of such infections in 2-5 years.
AIDS patients die of these infections. But AIDS does not kill people.
I hope you noticed that HIV infected individual would not know about his infection unless he takes a test at a clinic. A healthy young man will never go to a doctor because he has couple of days of flu like fever. Even if he goes to a doctor, I doubt the doctor will ask him to get a HIV test.
Meanwhile, the patient, if sexually active, will infect his sexual partner(s) without his knowledge.
Most of the HIV transmission in India occurs via sexual intercourse. Other means of transmission are blood transfusion, injection needles (intravenous drug use) and mother to child at birth.
The first case of HIV in India was discovered in 1986. Now, after almost 20 years, millions of Indians are infected. It is projected to multiply another 5-fold in next 5 years.
Now examine the statements of Khushboo, Suhasini and Sania in this context. Do not shoot the messenger, because you do not like the facts. One HIV infection in 1986 in India spread to a million infections before Sania heard the word, “sex”. Calling Sania irresponsible is a big joke, when the society failed in its responsibility to arrest the spread of this virus and save millions of lives.
I will talk about the science of HIV virus in the next posting.
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The HIV Life CycleNovember 30, 2005
HIV is a retrovirus that has RNA as its “blueprint” for replication (reproduction). It carries minimum genetic material to survive and subvert the host cells. It uses the machinery of the host (human) cells to reproduce itself. Like some smart computer viruses, it has minimum code, but uses the computers physical resources and software codes to reproduce and spread.
The following are the key steps in the life cycle of HIV:
(1) Attachement: First it has to attach to host cell. HIV can attach only to those cells that have CD4 receptors on the surface. The T-helper cells, a kind of white blood cells (which are an important part of human immune system) have lots of CD4 receptors and are the main target of HIV infection. After attachment, the virus fuses into the cell and releases it double stranded RNA.
(Efforts to intervene at this stage and stop the virus from attaching to a human cell failed so far in producing viable medicines.)
(2) Transcription: An enzyme called Reverse Transcriptase (RT) of the virus copies the RNA into DNA using the resources of the host cell.
(The first class of HIV drugs on the market stop the RT enzyme from turning viral RNA into DNA. Examples are retrovir, AZT) and sustiva, EFV.)
(3) Integration. The newly formed viral DNA is transported into the nucleus, and is integrated (attached) by HIV Integrase into the host DNA. HIV Integrase is another viral enzyme. Now, HIV DNA is hidden into the DNA of the host cell.
(Inhibition (stooping) the function of HIV Integrase is an active field of research, but no luck yet with Integrase inhibitors)
(4) Replication: Host cells are now tricked into making lots of copies of HIV. There are several steps involved here. The double helix DNA is separated into single strands, copied (transcription) into complementary strands of RNA called mRNA. Each mRNA strand directs the cell to make a long chain of polyprotein consisting of all virus proteins and enzymes.
(Few opportunities for intervention at this step are available, as all processes are part of normal cell functions).
(5) Budding and maturation: In the last step, the long polyprotein is cut at about 8 junctions into the right components (proteins and enzymes) which are organized to form a mature virus particle. The molecular scissors used at this step is a viral enzyme called HIV protease.
(HIV protease inhibitors are an important class of potent medicines that have revolutionized HIV/AIDS treatment in mid 1990s. These are expensive to manufacture, and are not widely available outside the US and Europe. The author is a co-inventor of one of these HIV protease inhibitor drugs. See
http://inventors.about.com/library/inventors/bl_protease_inhibitors.htm)
Go to
http://www.hopkins-aids.edu/hiv_lifecycle/hivcycle_txt.html see an animation of these key steps.
Next posting, I will talk about how virus overwhelms the body’s immune system leading to full-blown AIDS.
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HIV progression to AIDSDecember 4, 2005
In the last posting, I talked about the life cycle of HIV. That is a story of a single virus particle. It was technical and boring. I received questions from only one person regarding that topic. I will try to make this posting less technical and more interesting.
The mean life-span of the virus particle in blood plasma is 0.3 days. It is eliminated easily by the immune system. But a few viruses which survive long enough to infect human cell takes a minimum of 1.2 days to complete the life cycle and produce the new viruses. The cytotoxic (killer) T-cells destroy these infected CD4 cells. Initially, the body’s immune system wins. But the virus has several mechanisms to evade the onslaught of the body’s defenses. Slowly, HIV infection is established. More and more viruses are produced. It was only in 1995 that scientists found out that the virus had high turnover, producing about 10 billion new viruses per day. The viruse infects and destroys a CD4 T cell in about 2 days. The immune system replenishes the body with new CD4 cells by getting into an over production mode. A healthy individual has about 1000 CD4 T cells per cubic millimeter of blood. After some time, body’s resources for producing new CD4 cells are exhausted and average CD4 cell count falls below 1000. As long as CD4 cell count is above 500, the HIV+ individual looks and functions as a healthy individual. This asymptotic (no symptoms) state lasts as long as 10 years. At this stage, patient has 1000 - 100,000 copies of HIV in one cubic millimeter of blood. Once the CD4 cell count falls below 200, and viral load is at 50,000 copies, it becomes difficult for body’s immune system to defend the body from other infections. The symptoms of AIDS begin at this stage and become acute at CD4 cell counts below 50. At CD4 cell count of 50, it is almost impossible for patient to survive without assistance of medicines that fight infections.
Fortunately, medicines (Reverse Transcriptase Inhibitors and Protease Inhibitors) are available to fight the HIV infection, which bring down the virus to 100s of copies and increases the CD4 cell count above 200, and allow a patient to live normal life. But it is not possible at this point to cure the patient of HIV using the existing drugs. Virus in a latent form hides in various body tissue that are beyond the reach of drugs (Like TB bacteria remains silent and undetectable for many years).
Due to high rate of HIV turnover, and the high error rate of HIV Reverse Transcriptase enzyme, which makes copies of DNA from virus RNA, it becomes easy for virus to mutate (change its shape) and develop resistance. So drug therapy for a patient has to be carefully monitored and changed frequently to avoid resistance. This creates another big challenge for any heath care system. In addition to socio-economic problems, unavailability of trained physicians makes it difficult to control AIDS epidemic in India. It is not as fashionable to be an AIDS doctor in India as it is to be a heart surgeon etc.
The ability of virus to mutate (and change almost all of its parts) made it impossible so far to develop a vaccine (like polio vaccine or Hepatitis B vaccine). New HIV vaccine trials were announced in India on AIDS day. If successful, it will take about 7 years for the vaccine to become available.
In early 1990s, doctors in the US resorted to some desperate methods to cure HIV. It is known that virus does not survive at high temperature. To take advantage of this vulnerability of the virus, doctors made a patient’s blood to circulate through a dialysis like system out side body and raised the temperature for a short duration, cooled back to normal temperature before entering the body. That did not help at all.
In another attempt, scientists made truncated versions of CD4 cells that are soluble in blood, and injected these new cells into the body, hoping that virus will bind (attach) to these artificial CD4 cells and cleared before they bind to the real CD4 cells. It was not known at that time that virus produces 10 billion cells per day. It is impossible to inject enough truncated CD4 cells to neutralize the virus.
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ABCD of AIDS preventionDecember 11, 2005
In the past postings we learned the following facts about AIDS:
HIV causes AIDS. HIV infection is confirmed only by a blood test. No obvious symptoms appear in HIV+ individuals for years, while they can infect others.
No vaccines are available. Medicines are available to treat HIV/AIDS patients and prolong a healthy life for 10 or more years. These medicines need to be changed frequently to avoid resistance. Medicines are expensive.
There is no cure for AIDS.
There are three ways (ABC) to protect oneself against HIV infection, and one way (D) to reduce incidence of infection in a community.
The ABCD of HIV prevention are:
·
Abstinence
·
Be Faithful
·
Condoms
·
Disease control
Abstinence is the best way to protect yourself against HIV infection. If you are young and unmarried, the safest sex is no sex! No sex before marriage is norm for most people in India. Practice of abstinence by young before marriage provides other benefits, such as prevention of other sexually transmitted (painful and deadly) diseases, and unwanted pregnancies.
Be Faithful: If you are married, mutual faithfulness is the best way of protecting yourself and your spouse against HIV and other sexually transmitted diseases. Monogamy is practiced in Indian society by most married couple. If everyone in a community practices this virtue, there is no chance for HIV to take a hold in that community. For this to be absolutely successful, two additional conditions must be followed: (1) no sex before marriage and (2) mutual faithfulness in marriage.
Condoms: In every community, society and country, there is a small fraction of population who fail to follow the A and B rules. No society or culture, east or west has been 100% compliant with the top two basic rules. It feels good to think that AIDS is a problem for the immoral West and is not possible on our
punya bhoomi - pure and perfect
mera desh mahan. But that is a denial of facts. We have
Chilakaluripeta and
Peddapuram on Telugu Bhoomi for longer than many of us know.
Even though it is a tiny fraction, some young and unmarried people become sexually active and indulge risky sexual behavior. And some break the vows of marriage and engage in sex outside marriage. For such people, who put themselves at risk for sexual pleasure, must take responsibility to protect themselves against HIV. The best way to protect oneself in such situations is to use condoms.
If used correctly, condoms will give a very high level of protection against HIV infection. Condoms do fail, but mostly due to improper use, slippage and breakage etc. Studies have shown dramatic reduction in the rate of HIV infection due to condom use.
Disease control: It is convenient to think that people with low morals and people who engage in illicit sexual activities are affected by this deadly disease. Everyone else is safe. Not true.
Take an example of a young man, who met with a road accident, was given blood during a required medical procedure. The blood was contaminated with HIV and he gets infected. He passes the infection to his wife and she gives birth to a baby who gets infected during birth. These three innocent individuals got infected with HIV due to the failure of screening of donated blood.
All three incidents occurring in sequence in one family may be very rare, but there are lots of recorded cases of one or two of these incidences of HIV transmissions: (1) HIV via contaminated blood, (2) HIV+ husband infecting his innocent wife, or (3) Child getting infection during birth.
To minimize these types of infections, our blood supplies should be 100% safe. The high-risk individuals (such as sex workers and long distance truck drivers) must be properly educated, and given advice to protect themselves. Suspected individuals should be tested for HIV and made aware of the danger of transmission if he/she practices unprotected sex. Mother to child transmission during childbirth can be minimized dramatically using cheap antiviral medicines. The public and private health care system should be engaged in these activities to control this deadly disease. Anyone (Khushboo, Sania or anyone else) who is spreading awareness about HIV should be encouraged.
Remember: Anybody can get infected with HIV, but nobody has to get infected. In most cases HIV/AIDS is 100% preventable.
