SARS research and the lessons of HIV

HIV-positive people with compromised immunity who contract the SARS virus may be more seriously affected by the illness, according to the Australian Federation of AIDS Organisations (AFAO).

AFAO treatments officer Ross Duffin told Sydney Star Observer SARS had yet to be observed in people with HIV and therefore there are no definitive answers yet -“ only informed speculation. SARS was likely to be more of a risk to some people with HIV.

People [with HIV] who are on treatments and have good immunity aren’t going to be any different from other people, Duffin said, noting people living with HIV/AIDS were not necessarily more susceptible to contracting SARS.

If they do contract it, however, then the informed speculation is that people with HIV with compromised immunity are more likely to get serious symptoms of SARS [and] are less likely to be able to clear the disease, he said.

Duffin’s comments followed a statement by French biologist Luc Montagnier in Agence France Presse this week. Montagnier said death rates from SARS would be higher among people with HIV/AIDS.

Duffin suggested HIV-positive people with reduced immunity take extra precautions simply because the disease is likely to be worse. At the moment those precautions involve avoiding travel to locations where there is local spread of the disease. (Presently there is no local spread of SARS in Australia.) An official statement about SARS and HIV/AIDS will be posted on the AFAO website (www.afao.org.au) next week.

The SARS virus has sparked some familiar social, political and cultural responses worldwide. The hysteria that accompanied the initial outbreak of HIV/AIDS has been reflected in headlines like WORSE THAN AIDS -“ in Sydney’s Daily Telegraph -“ and comparisons between HIV’s Patient Zero (Gaetan Dugas) and the alleged super-spreaders of SARS. Many reports have also ignored the low mortality rate of SARS (estimated to be less than 10 percent).

There have been similarities between the public response to SARS now and AIDS then. The Guardian’s Rod Liddle noted this week a similar pattern of xenophobic mythology established itself during the early stages of Asian flu, AIDS and the Ebola virus. Nasty incurable diseases are almost always the fault of foreigners doing despicable, uncivilised things, usually with animals. Within Australia, The Sydney Morning Herald reported there was no need to avoid the Chinese community or Chinese businesses, a tacit acknowledgment of prejudices currently circulating.

A less controversial connection between the two viruses is the increasing involvement of prominent HIV/AIDS researchers in controlling the outbreak of SARS. Professor Ron Penny, who diagnosed the first case of HIV/AIDS in Australia, was appointed by the NSW government to oversee preparations for a possible Australian SARS outbreak. Penny played down any significant biological or cultural similarities between the viruses. I don’t think there are parallels between HIV and SARS [except in] public education in the face of a new epidemic, Penny told The Sydney Morning Herald.

Lessons learnt from the HIV epidemic could be advantageous, a number of international AIDS educators and researchers have noted. Dr David Ho, from the Aaron Diamond AIDS research centre in New York, told the Wall Street Journal that given all the lessons we’ve learned from HIV, this one looks easier.

Duffin agreed: I think the first lesson is that people responded earlier [to SARS].

Initially people were really critical of the World Health Organisation acting early. I think no one now would disagree that they weren’t right for acting early. Whereas in HIV it took people a lot longer to do the things that would have had a significant impact on longer-term outcomes. The other thing is that the technologies needed to control SARS are quite a lot easier than HIV. HIV relies on interventions in human behaviour, which are never universally successful, whereas technologies that don’t rely on human behaviour may control the spread of SARS.

The full impact of SARS was yet to be seen, Duffin said.
It’s possible that SARS could be devastating for large populations in the world, but again we’re stressing that in seven months there’s been 300 deaths and there’s probably been millions and millions of people in areas where risk occurs and there’s been a lot more people infected than deaths.

In Toronto there are hints that they have managed through infection control to control the outbreak. But the virus does seem to have quite a foothold in China, where there are a billion people and where the sorts of technologies that they can apply to prevention don’t exist in the same way that they do in Toronto.

Government policies have also impacted on SARS prevention in China, where responses to HIV/AIDS and SARS have been remarkably similar.

According to Christopher Horton in Asia Times Online, China has presented few AIDS education campaigns. A recent survey of Chinese university students revealed fewer than half of the respondents knew how HIV was transmitted.

The histories of both HIV and SARS in China have one striking shared characteristic -“ Beijing’s knee-jerk suppression of all relevant information out of fear of damaging China’s economic growth … Horton said. In both cases, the Chinese population is paying the price.