HIV-2: How are we not all dead?

I’ve been reading tons of books on emerging viruses and watching TV shows like the Syfy channel’s new HelixNot only am I convinced humankind is on the brink of annihilation, I’m actually surprised we’re not all dead yet. My latest fright came from reading up on the origins of the name “HIV” for the virus that causes AIDS. I was trying to get the timeline correct before my blog entry on how badly the makers of The Dallas Buyers Club got some of the specifics wrong. What I found really blew my mind.

HIV-1 up close

HIV-1 up close

Did you know that there are two types of HIV? I thought that I was well-educated because I understood that the virus could mutate into slightly differing forms and that this is why creating a vaccine is challenging for all viruses — that’s why our flu vaccine each year targets several strains instead of there being a “universal” flu vaccine. I sort of had that right. But not really.

There is actually HIV-1, and that is the virus that has so tragically killed all of my gay brothers throughout the United States and Europe. HIV-1 comes in all types of lovely subtypes, wherein type “M” is the most common “major” grouping. It is composed of subtypes A, B, C, D, F, G, H, J, and K. Sometimes, two of the subtypes meet up and have babies (called circulating recombinants) such as CRF A/B — the result of subtype A meeting up with subtype B in a cell and mixing up all of their genetic material to create something new and horrible and deadly. In addition to the major grouping “M”, there is the “outlier” group “O” and the “new” group “N”. Some scientists suspect that the types M, O, and N were created during specific, unrelated jumps of monkey viruses to humans.

All of these different subtypes can be tied to areas of the world where they are most common. For instance, subtype C is what’s infecting everyone in Africa. Subtype B is what wiped out San Francisco and NYC.

And it gets worse. You can get infected with one subtype of HIV and then get “coinfected” with another. Then they double team your body to make things even worse. Scientists didn’t always believe that this was possible. In fact, in the 80’s when the CDC was trying to get the gay men of the US to alter their sexual habits, they specifically said that things would be fine if all HIV+ men slept with other positive men, and all HIV- men slept with only negative men. They mistakenly lead the positive men to believe that they didn’t need to protect themselves anymore. I don’t think this issue is common knowledge even today.

And it gets even worse. This is all without mentioning HIV-2. HIV-2 causes a disease like AIDS, but it isn’t AIDS. It just seems like AIDS. I’m a little confused by that. I’m also a little confused by the fact that we don’t test for HIV-2. Supposedly, it is really rare, and that is why we don’t test for it. I’d love to hear someone explain that to me. Back in 1976, HIV-1 was pretty rare — but it sure would have saved a lot of lives had we been able to test for it…did test for it. Why is HIV-2 not a threat? Available treatments for HIV-1 related AIDS are not effective on HIV-2 related AIDS, so it seems like it would be a HUGE threat to all of us.

Why have I not heard more about this, and why aren’t we more frightened?

Thanks to www.foundcare.org for sharing this information.

Dallas Buyers Club (Movie, 2013)

Dallas Buyers Club

Dallas Buyers Club

I recently took in a showing of The Dallas Buyers Club, a movie centering around the attempts of main character Ron Woodroof (played by Matthew McConaughey) to fill the void for those dealing with AIDS in the early 80’s without any hopeful medical treatments available. A real-life character, Woodroof started one of many so-called “buyers clubs” — patient collectives that were structured to make end-runs around FDA policy and DEA regulations and get time-critical therapies to those desperate to try anything rather than risk certain death.

Before getting into the issues I have with this movie, I have to give props where they are due. McConaughey does that unbelievable, effortless-looking thing where an actor makes one forget he’s watching an incredibly famous person “act” at all. He lost a painful amount of weight to portray the character with stunning realness, but he doesn’t rely on the shock value of his skeletal frame to cheat us of an award-worthy performance.

With that out of the way, I have to say that I was very disappointed with a bit if historical inaccuracy in the story. I likely would not have picked up on it had I not recently digested the 700+ pages of Randy Shilts’ definitive account of the early years of the epidemic in And the Band Played On. But I did recently read the book, and I’m glad that I did so that I can remind other moviegoers about some key points incorrect in Dallas Buyers Club.

’85 Hudson Article

The film opens with Woodroof running a gambling racket at the local rodeo. We discern the date from the newspaper article beneath the money on the table — July 25th 1985, “Rock Hudson in Paris Hospital with AIDS”. Not too much farther into the film, Woodroof winds up in the hospital himself after collapsing. Later, in a clinic exam room, two doctors inform him that he has “tested positive for HIV, which is the virus that causes AIDS”. They give him 30 days to live.

Again, had I not just recently slugged through Shilts’ novel, I wouldn’t have remembered that in 1985, the only test available for HIV was the one approved by the FDA for use by blood banks and the manufacturers of blood products (e.g., clotting factor for hemophiliacs). It wasn’t available to the public, and it wasn’t used for routine hospital blood screens. In fact, it was illegal to give an individual the results of such a test and illegal to test without written consent. The former rule was supposedly meant to prevent homosexuals from using the public blood supply as a screening test (because it was not available anywhere else) — make it illegal to give them the results, and they have no reason to donate blood and continue infecting the blood supply. The latter was supposedly to prevent the test from being used by “big brother” as a de facto test of sexuality, given that initial research indicated that as much as 90% of the gay population was infected. For whatever the true reason, the test was not given to the average collapsed man on the street.

Also problematic for this scene is the issue that back in 1985, Luc Montagnier of the Pasteur Institute was still arguing with Robert Gallo of the University of Maryland that Pasteur’s LAV (lymphadenopathy associated virus) was the cause of AIDS as opposed to Gallo’s HTLV-III (human T-lymphotropic virus type III). Though they were later determined to be the same virus and collectively named “HIV”, this term was not widely used until at least a year after the time set for the movie’s diagnosis scene.

Leto (left) and McConaughey

So, in a nutshell, it was highly unlikely that two doctors would have entered Woodroof’s room and informed him that they had performed illegal blood tests on him and found that he tested positive for a virus from the future. I don’t think it happened that way. Am I just overly persnickety when I watch movies? Probably. But as I noted in my blog entry on Shilts’ book, it is difficult to comprehend the horror of living in those times as a member of one of the “at risk” groups (i.e., homosexuals) and scientists not only unable to treat the illness, but also unable to test for it or have definitively discovered the cause. That is straight up the plot of a horror movie, and the gay community lived it. It is important to me for people not to forget this. The community suffered from a collective PTSD-worthy situation — living virtually the life of the walking dead. I wanted the movie to make this more clear.

That brings me to my problem with the character Rayon (played awkwardly by Jared Leto). Rayon is a transgender female who is remarkably unable to provide any noticeable point of view from the GLBT community. Though this is a story based on true events, Rayon is not one of them. Some have wondered if the character was added as a concession to the GLBT community of some sort — throw in a trans woman so that they don’t think they have co-opted the subject matter. I can assure the producers of the film, there is no way that you can ever co-opt AIDS from the GLBT community. Whether we want it or not, AIDS history is intertwined with ours.

FINAL VERDICT: See the movie. It’s a great movie with an incredible performance by McConaughey. Just do me a favor and share some of these facts with your friends on the ride home so that I feel like my persnickety efforts have not been in vain.

And the Band Played On…and On…and On

And the Band Played On

And the Band Played On

I was speaking with a friend the other day about comics, jokes, and dark humor. One of the things upon which we completely agree is that AIDS is not funny, and there is likely never going to be a funny AIDS joke. The title of this post is about as close as I think one can come, and it is simply a dig at how incredibly long and detailed of a work is Randy Shilt’s novel, And the Band Played On: Politics, People, and the AIDS Epidemic. Even Publishers’ Weekly describes the book as “an exhaustive account” of the early years of the AIDS crisis. That being said, it is mesmerizing.

The book begins way back in the 70’s with a CDC expedition to Africa to fight the original Ebola Zaire outbreak, and it continues through 1987 — right after the LAV/HTLV-III viruse(s) were renamed HIV and the “Western Blot” antibody test was released.  Given that I was only about 5 years old at the start, the timeline was very crunched in my memory. It was a welcome refresher as to how little we knew for so long about so many aspects of the disease. On the other hand, it was heart wrenching to hear recounted the political speeches promising a vaccine within 2 years…25 years later now with no vaccine in sight.

It is good for us all to have a fat dose of historical reality now and then. Not long after reading this book, I saw the movie, Dallas Buyers Club 1, about a Texas man who smuggled drugs into the USA so that AIDS patients could have access before the long process of FDA approval was complete.  What interested me most about the movie is the level of inaccuracy of detail regarding HIV/AIDS history.  I likely would not have picked up on it had I not recently digested the 700+ pages of this story with its almost day-by-day breakdown of the outbreak.  One of the most powerful elements of this real life story, for me, is that people were dying for so long without having any idea *what* was killing them.  Can you imagine having all of the people in your life mysteriously dying while no one outside your neighborhood seems to care at all?  It’s a horror movie come to life.

1993 Movie Version

1993 Movie Version

If you’re gay, read the book! If you’re young enough not to have been there, educate yourself on what happened and how the US government allowed it to happen to us because of our unspeakable sexuality (literally, President Reagan would not speak of it for years).  If you’re old enough to have been there, it’s a good reminder about how far we’ve come − from unspeakable to Will & Grace to the right to marry.

SIDE NOTE: The book was made into a 1993 TV movie starring Matthew Modine and Allen Alda as the main two characters, Dr. Don Francis and Dr. Robert Gallo.  700+ pages cannot be translated into 120 minutes, so obviously it’s like apples and oranges to compare the two. I did revisit the film after reading the book, and it *does* manage to hit a couple of points really well: (1) the government let us die because we’re queer, and (2) the gay community and its leaders had its own self-defeating role to play in it all.  Sir Ian McKellen, Phil Collins, Lily Tomlin, and Richard Gere add to the surprising star power given to the made-for-TV movie.

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  1. It profoundly bothers me that in no place (around the web or in newspapers) have I seen an apostrophe used in the title to this movie.