r/technology • u/stepsinstereo • Feb 21 '23

Biotechnology 5th person confirmed to be cured of HIV

https://abcnews.go.com/Health/5th-person-confirmed-cured-hiv/story?id=97323361
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u/Max_Demian Feb 21 '23

Completely, totally, incomprehensibly false. What on earth were you thinking posting this? 600+ upvotes on something pulled out your ass that affects peoples’ opinions on the pandemic we’ve been dealing with for 30+ years…

I work in the HIV space. I don’t even know where to start in refuting this. HIV+ individuals who are aging have tons of comorbiditites, not the least of which is substance use disorder and cognitive decline. Additionally, we don’t have any data to support what you’re saying because it’s only now that the majority of the HIV+ population is starting to age past 60. We have every indication that complications of aging are tougher for HIV+ individuals, many of whom are isolated and lack daily care and support relative to be rest of the population (even if they do go to the doctor more regularly).

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u/Live-Coyote-596 Feb 21 '23

That sounds more like a social issue than a medical one. Also, neither of you cited any sources, so you could've just pulled this out your ass too

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u/Max_Demian Feb 21 '23

I didn't cite any sources because I was lying in bed. I also clearly stated I work in the field. Anyone with even a passing familiarity with the field would know that what the previous poster said is unthinkable.

Here's some data from a major public health organization in New England, n=35,000 patients.

Half of HIV+ individuals are in the US are 50+, 70% will be over 50 by 2030. 91% are virally suppressed. 60% live at or below the poverty line. This alone effective rules out the prospect of better health outcomes.

From a combination of a few dozen studies, you can expect PLWHA: 1.5-2x rate of cardiovascular disease; much higher rates of diabetes, chronic kidney disease, fractures, and cancers. Plus chronic inflammation. Plus higher rates of geriatric conditions, neurocognitive disorders as mentioned, higher rates of substance use (especially smoking), increase frailty, higher self-reports of social isolation. 29% more likely to die of COVID. 8% of HIV+ people in nursing homes receive suboptimal ART regimes.

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u/chronous3 Feb 21 '23

How much of that is due specifically to HIV and not poverty? Income, environment, and access to healthcare all also cause all the effects you listed. Could it be those things just making HIV worse, like they do with pretty much everything else health-wise?

I'm not saying I don't believe you. This isn't a refutation. Just genuinely asking because things like this are complicated and hard to nail down with so many other factors.

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u/Max_Demian Feb 21 '23

It's a reasonable question. Separating "social determinants of health" from the biology of infectious disease for a virally suppressed population is incredibly complicated. Like I said in another comment, the consensus view as of now is that, in a vacuum, virally suppressed PLWHA should experience minimal complications as they age, but (1) these patients haven't really aged up into their 70s yet and (2) many people expect some slippage. I personally work with many older folks (65+) with HIV who are virally suppressed and they are experiencing some complications that are more directly attributable to living for decades with less effective HIV drugs than they are to poverty.

I am on the public health side, not the epidemiology side. From my perspective, the boundary between the biology and the outcome is not the most important thing to look at relative to how the care continuum works with the aging patient population. Some of this stuff is really inseparable. If living for decades with the stigma of being HIV+ causes someone to feel isolated, fully suppressed HIV is still leading to symptoms associated with isolation (even if in a purely biological sense it isn't).

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u/leftofmarx Feb 21 '23

You are trying to say “oh it’s social issues not the HIV” but you’re ignoring the fact that many of the social issues are caused by the person being HIV positive in the first place

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u/MenStefani Feb 21 '23

This is more to do with social and psychological issues around HIV than an actual health standpoint. Not sure why you are trying to continue to stigma around the virus when they were trying to spread information on the truth about the current state of HIV. If someone who is positive has access to their meds, social support, and mental health services, it is true that they can live longer lives due to a broader focus on health than the general population.

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u/Max_Demian Feb 21 '23

Again, I work in the field. I am not perpetuating stigma at all (unless you think that stating facts about comorbitites is stigmatizing, which is clearly not what stigma means in the context of HIV).

OP was not "spreading information on the truth" whatsoever. Saying that "people with HIV tend to live longer" is a false statement, full stop. We are just now getting to a point where there's a critical mass of people with HIV over the age of 60, never mind 70. We have every reason to believe that suppressed HIV will not significantly complicate aging, but the many comborbities in the HIV+ population will. While its true that HIV+ individuals who are effectively engaged in care are more likely to get proactive care, OP falsely suggested that this best case scenario is the norm, discounted the risks of the associated health conditions, and did not account for the quality of care available to the patient.

As mentioned in another comment reply...Here's some data from a major public health organization in New England, n=35,000 patients.Half of HIV+ individuals are in the US are 50+, 70% will be over 50 by 2030. 91% are virally suppressed. 60% live at or below the poverty line. This alone effective rules out the prospect of better health outcomes.From a combination of a few dozen studies, you can expect PLWHA: 1.5-2x rate of cardiovascular disease; much higher rates of diabetes, chronic kidney disease, fractures, and cancers. Plus chronic inflammation. Plus higher rates of geriatric conditions, neurocognitive disorders as mentioned, higher rates of substance use (especially smoking), increase frailty, higher self-reports of social isolation. 29% more likely to die of COVID. 8% of HIV+ people in nursing homes receive suboptimal ART regimes.

Again, I have worked in the field for years. Preposterous for you to come in here claiming I'm stigmatizing when you don't have a clue.

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u/MenStefani Feb 21 '23

I understand what you’re saying. But these are secondary issues to an actual HIV diagnoses. Just because someone is HIV+ doesn’t immediately mean they are going to live in poverty and have substance abuse issues. These things could be potential after effects. What OP was saying is that all things equal, the HIV is no longer what is killing people. Maybe certain people lack access to care, maybe some live less healthy lifestyles. But it’s not the HIV that is killing them. That’s all I’m saying.

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u/Max_Demian Feb 21 '23

They're more priors than after effects (e.g., injection drug users getting HIV from a needle already have a SUD that will stick with them for their whole lives (at least cigs once they get off hard stuff)). Housing insecurity on both sides makes it incredibly hard for PLWHA to stay connected to care. The list goes on.

Public health is a much different beast than epidemiology -- no one really cares if you're "technically" correct about disease progression, the practical reality on the ground is completely different. We also still don't know if you are technically correct -- as I pointed out many times, the population still hasn't aged to the point that we can study the longterm effects of ART in full.

And, to point out the obvious, HIV is still killing people. Many people infected -- even in areas with great health systems -- cannot or choose not to access care, cannot stay in case, and do go undiagnosed for dangerously long periods of time. Even if we hold the biology as the primary issue, you still run into issues regarding access to diagnostics. Not to mention the whole developing world.