The Philippines: an idyllic country with some of the clearest water and bluest skies on the planet. It is also the epicenter of one of the fastest-growing HIV epidemics in the world. On the surface, it seems as if we are just a late bloomer. However, the reasons for our current epidemic are much more complicated and may foreshadow a global resurgence of HIV.
Filipinak: herrialde amesgarria mundu osoko ur eta zeru gardenetarikoekin. Baita HIESaren epidemiaren epizentro garrantzitsuenetarikoa Itxuraz, agerraldi berantiarra baino ez dela dirudi. Baina epidemia honen arrazoiak askoz konplexuagoak dira eta mundu mailako agerraldi berri baten zeinu izan daitezke.
While overall new cases of HIV continue to drop in the world, this trend may be short-lived when the next wave of more aggressive and resistant viruses arrive. HIV has a potential to transform itself into a new and different virus every time it infects a cell. Despite the remarkable progress we've made in reversing the epidemic, the truth is that we are just a few viral mutations away from disaster.
Mundu osoan kasu berrien kopurua gutxitzen ari den bitartean, joera hau laburra izan daiteke agresibo eta erresistentzia handiagoko birusen olatu berri bat iristerakoan. HIESak, zelula bat infektatzen duen bakoitzean, bere burua beste motako birus batean transformatzeko gaitasuna du. Birus honi aurre egitego garapen esanguratsuak lortu baditugu ere, egia esan hondamenetik mutazio gutxi batzuetara gaude.
To appreciate the profound way in which HIV transforms itself every time it reproduces, let's make a genetic comparison. If we look at the DNA variation among humans of different races from different continents, the actual DNA difference is only 0.1 percent. If we look at the genetic difference between humans, great apes, and rhesus macaques, that number is seven percent. In contrast, the genetic difference between HIV subtypes from different patients may be as much as 35 percent. Within a person infected with HIV, the genetic difference between an infecting mother virus and subsequent daughter viruses has been shown to be as much as five percent. This is the equivalent of a gorilla giving birth to a chimpanzee, then to an orangutan, then to a baboon, then to any random great ape within its lifetime.
HIESAren aldakortasuna ikusi ahal izateko, birusa erreproduzitzen den bakoitzean, goazen alderatze genetiko bat egitera: Giza arrazen arteko DNA ezberdintasunei begiratzen badiegu, kontinenteetan zehar, DNA ezberdintasuna %0,1 baino ez da. Gizakien eta tximinoen artean %7koa da. Alderantziz, ezberdinatsun genetikoa HIESaren moten artean gaixo ezberdinen artean %35koa izatera heldu daiteke. HIESArekin kutsatuta dagoen pertsona batean ama birusa eta bere seme birusen arteko ezberdintasun genetikoa %5rainokoa dela frogatu da. Gorila batek seme tximpanze bat izatearen balio bera du. Eta segidan orangutan bat izatea, gero babuino bat, eta gero edozelako tximino espezie bat izatea.
There are nearly 100 subtypes of HIV, with new subtypes being discovered regularly. HIV in the developed world is almost all of one subtype: subtype B. Mostly everything we know and do to treat HIV is based on studies on subtype B, even though it only accounts for 12 percent of the total number of cases of HIV in the world. But because of the profound genetic difference among different subtypes, some subtypes are more likely to become drug-resistant or progress to AIDS faster.
Gutxigorabehera 100 HIES mota daude eta maiz mota berriak aurkitzen dira. HIESa mundo garatuan ia mota batekoa baino ez da: B mota. HIESari aurre egiteko dakigun ia guztia B motaren ikerketei dagokie. Baina mundu osoko kasuen %12 baino ez da. Ezberdintasun genetikoaren ondorioz, HIESaren moten arteko batzuk drogei aurre egiteko gaitasun handiagoa dute edota azkarrago garatzen dira.
We discovered that the explosion of HIV cases in the Philippines is due to a shift from the Western subtype B to a more aggressive Southeast Asian subtype AE. We are seeing younger and sicker patients with high rates of drug resistance. Initial encroachment of this subtype is already occurring in developed countries, including Australia, Canada and the United States. We may soon see a similar explosion of cases in these countries.
Filipinetako HIES kasuen eztanda, mendebaldeko B motatik Asia hego-ekialdeko AE mota agresibo baterako aldaketari dagokiola aurkitu dugu. Gaixo gazteagoak eta kaltetuagoak ikusten ari gara sendagaiei erristentzia handiagoarekin. Mota honen lehen aztarnak jadanik ikusten ari dira herrialde garatuetan, hots Australia, Kanada eta Estatu Batuak. Denbora gutxira kasu eztanda berdin bat ikusteko probabilitate handia dago.
And while we think that HIV is done and that the tide has turned for it, just like with real tides, it can come right back. In the early 1960s, malaria was on the ropes. As the number of cases dropped, people and governments stopped paying attention. The result was a deadly resurgence of drug-resistant malaria.
HIESarekin bukatu dugula pentsatzen dugun bitartean, eta gaixotasun honen bolada joan egin dela pentsatzen dugun bitartean, berriro agertzea izan liteke. 1960ko hamarkadan, malaria ia garaitua zegoen. Kasuen kopurua behera zihoan bitartean, jendeak eta gobernuek jaramon egiteari utzi zioten. Ondorioz sendagai-erresistentzia zuen malaria baten berragerraldi bat izan zen.
We need to think of HIV not as a single virus that we think we've figured out, but as a collection of rapidly evolving and highly unique viruses, each of which can set off the next deadly epidemic. We are incorporating more powerful and new tools to help us detect the next deadly HIV strain, and this needs to go hand in hand with urgent research on the behavior and proper treatment of non-B subtypes. We need to convince our governments and our funding agencies that HIV is not yet done.
HIESean pentsatzean ez dugu garaitu dugun birus bakar batean pentsatu behar, baizik eta azkar garatzen ari den birus talde anitz batean, non birus bakoitzak hurrengo epidemia hilkorra sortu dezakeen. Erreminta berri eta indartsuagoak sortzen ari gara hurrengo HIESaren mota hilkorra detektatu ahal izateko eta honek premiazko ikerketa baten ondoan jorratzeko beharra du. B mota ez diren moten bilakaera eta sendatzeko modua ikertzeko. Gobernuei eta agentziei buruan sartu behar diegu HIESarekin ez dugula bukatu.
Over 35 million people have died of HIV. We are on the verge of an AIDS-free generation. We need to pay attention. We need to remain vigilant and follow through. Otherwise, millions more will die.
HIESak 35 milioi pertsona baino gehiago hil ditu HIESarik gabeko generazio bat lortzeko aukera dugu. Kontuz ibili behar gara. Erne ibili eta horrela jarraitu behar dugu Bestela, milioika pertsona gehiago hilko dira. Eskerrik asko.
Thank you.
(Applause)
(Txaloak)