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Aggressive subtype behind HIV rise in the Philippines?

Ana P. Santos Interview
March 9, 2018

A more aggressive and possibly drug-resistant HIV subtype may be behind skyrocketing HIV infection rates in the Philippines. Epidemiologist Edsel Salvana tells DW that the strain is threatening to spark a new epidemic.

HIV and AIDS in the Philippines
Image: Pulitzer Center/DW/V. Villafranca

Remarkable advancement in the prevention, management and treatment of HIV, the virus that causes AIDS, has led to a global decline in HIV as well as in new infection rates. The Philippines, however, remains an outlier.

The country has the fastest growing HIV epidemic in the Asia-Pacific region.

The total number of new HIV infections in the Philippines increased by 140 percent from 2010 to 2016, according to the Philippine Department of Health (DOH) and UNAIDS, the United Nations agency on HIV and AIDS.

DOH data show that as of December 2017, there were 50,725 reported cases of HIV in the Philippines. And the agency forecasts the total number of HIV cases in the country to reach 142,400 by 2022.

In an interview with DW, Dr. Edsel Salvana, Director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines, talks about the aggressive strain — the HIV AE subtype — and its implications for Philippine society. 

DW: Give us an overview of this HIV subtype AE and how it is affecting HIV infection rates.

Edsel Salvana: The HIV virus has the potential to transform itself into a new and different virus each time it affects a cell. There are nearly 100 different subtypes of HIV, with new subtypes being discovered every day.

HIV crisis in the Philippines

Most HIV infections in the Western world are of subtype B. Most of the research that we have on HIV is also on subtype B though it accounts for only about 12 percent of all global HIV infections.

We have discovered that the explosion of HIV in the Philippines is due to a shift from the Western subtype B to a more aggressive HIV subtype AE. Those infected by the HIV subtype AE are younger, sicker patients who are more resistant to antiretroviral (ARV) drugs. We are also seeing a faster progression to AIDS under subtype AE.

What are the implications of this HIV subtype AE?

HIV is not done yet. We cannot think of HIV as a single virus but as a collection of viruses that are evolving, with a new mutation that can possibly set off a new epidemic. The truth is we are just a few viral mutations away from a resurgence of HIV — and it is not going to look like what it used to look like. It will be worse. If we are not vigilant, we are going to be caught deeply unprepared.

What then needs to be done to prevent this?

The gains that we have made in decreasing HIV infection rates will be short-lived without research and treatment for HIV subtype AE. This is urgently needed. Specifically for the Philippines, we need more scientists willing to do research work on HIV. To do this, we need to make access to government research funds more efficient. The current government procurement procedures are tedious and slow, which causes further delay in research.

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What are your thoughts on the move to amend the existing HIV law and lower the age of HIV testing without parental consent to 15?

This is long overdue. We also need to consider moving from a voluntary approach to testing to what the Center for Disease Control and Prevention recommends as the "opt-out" approach where patients are informed that an HIV test will be conducted unless they explicitly decline to be tested. This approach is meant to help identify persons living with HIV who may otherwise not volunteer or subject themselves to testing because they do not think that they are at risk of HIV infection.  

Condoms have always been a hard sell in conservative, Catholic Philippines. What are your thoughts on how to aggressively promote condoms in HIV prevention?

I have always advocated calling condoms something else, maybe something like "a sexual health promotion device" to dissociate it from contraception. Condoms are collateral damage resulting from the Catholic Church's stand on contraception and if we can get away from that label and present it as a health promotion and prevention tool — which it is anyway — it might be more acceptable.

Dr. Edsel Salvana is Director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines, Manila, and is Clinical Associate Professor and Research Coordinator at the Section for Infectious Diseases of the Department of Medicine at the Philippine General Hospital.

The interview was conducted by Ana P. Santos.

Editor's note: The article's original headline, "New virus strain behind HIV explosion in the Philippines," has been changed. It has been brought to DW's attention that there hasn't been any new strain of HIV found in the Philippines.