1) How did you get into this field?
Dr. Nemechek said it all started when he was at UCLA in the late 1980's for his residency in internal medicine. He noticed that there were many young men who were dying and there was very little concern for them. These men were very low priority because they were either gay or drug users. There was overt bigotry throughout the hospital.
Originally, when Dr. Nemechek started his undergraduate studies, his goal was to be a high school teacher. This was because he has a strong belief of how to teach and he continued to carry that with him even as his goals changed. This came into play when the senior physician was teaching them during rounds. He was making comments that were immoral and horrible, all the while he had this huge influence on everyone around him. This influence was an abuse of his power and it struck Dr. Nemechek.
Dr. Nemechek said it all started when he was at UCLA in the late 1980's for his residency in internal medicine. He noticed that there were many young men who were dying and there was very little concern for them. These men were very low priority because they were either gay or drug users. There was overt bigotry throughout the hospital.
Originally, when Dr. Nemechek started his undergraduate studies, his goal was to be a high school teacher. This was because he has a strong belief of how to teach and he continued to carry that with him even as his goals changed. This came into play when the senior physician was teaching them during rounds. He was making comments that were immoral and horrible, all the while he had this huge influence on everyone around him. This influence was an abuse of his power and it struck Dr. Nemechek.
Because of all of his experiences during his residency he said, "HIV picked me." He couldn't raise his voice about all of the injustices because he would be thrown out of the program, but when he completed the residency program he was offered a teaching position in the hospital. In this position, Dr. Nemechek took all of the HIV patients. It was the first HIV clinic at UCLA and it was simply his residency clinic. Many people were speaking out about HIV patients and how they were not worthy of care until Magic Johnson announced that he was infected. After that, people stopped criticizing HIV patients out loud, but the emotions were still there. Whenever another doctor made a comment, Dr. Nemechek called him out about it because he believed that they were teachers and they were making an impression on the other doctors there.
Eventually, he was forced off of the teaching staff by the chief of surgery because he believed that Dr. Nemechek was trying to kill him by having him operate on HIV patients. He was never one to carry a banner before but in this instance Dr. Nemechek said, "It was one of those times to stand up and be counted." He said he would do it again, but the price would be higher.
Eventually, he was forced off of the teaching staff by the chief of surgery because he believed that Dr. Nemechek was trying to kill him by having him operate on HIV patients. He was never one to carry a banner before but in this instance Dr. Nemechek said, "It was one of those times to stand up and be counted." He said he would do it again, but the price would be higher.
2) Why does a doctor, especially one studying HIV and other retroviruses, need to know about evolution?
"Every doctor, in every field, needs to know about evolution." Dr. Nemechek explained how humans were designed to be prehistoric people. They were lean and survived on high protein. Their immune systems were built for when there was no food and for when they ate raw meat. Now we are trapped in a cultural context of what is healthy. For example, drinking eight serving of eight ounces of water is not needed to be healthy. The palaeolithic human did not need that to be healthy, so we don't either. Another example of how we were designed and how we don't live that way is diabetes. This is because of carbohydrates and obesity. The average American, now, eats one to two cups of carbohydrates a day. The prehistoric man ate one to two cups of carbohydrates a year. How we were designed explains how things function now. "We can go back and understand why something is the way it is now by looking at the past and they way it was then. If it hadn't worked, they [the organisms] wouldn't have survived."
3) Why is a search for the cure so important?
Dr. Nemechek said, "There really isn't a search for a 'cure.' That is not the goal in HIV medicine. Any time you use a treatment targeting DNA, the risks skyrocket." This is evident with the use of chemotherapy. When someone is treated with chemotherapy, the incidence of leukemia increases.
The goal of HIV medicine is to put the infection to a point where it is stable, or where the patient can live with the infection. All this takes is a small shift of something in HIV. Part of the problem of finding this is the cost and difficulties especially in other countries that have a higher rate of infection and lower living conditions. Another problem is that most deaths are caused by secondary infections that attack the immune system when the disease has progressed to AIDS. The heightened immune response at the start of the infection later leads to rapid decline when the later stages of AIDS are reached, the immune system is weakened, and no longer has the ability to fight off secondary infections a healthy individual could survive.
Dr. Nemechek said that we need to look to the populations of Sooty Mangabeys that live with SIV (Simian Immunodeficiency Virus). These apes have a high viral load but their immune system doesn't recognize it so the system doesn't kick in. If SIV is injected into Rhesus Macaques, who have never been exposed to the virus, it progresses much in the same way that HIV does in humans. Evolution explains why the Sooty Mangabeys can live with SIV and the Rhesus Macaques cannot. The Rhesus Macaques have not had the evolutionary pressures that the Sooty Mangabeys have to develop a resistance to the virus. Over time the immune systems of the Sooty Mangabeys have developed in a way that it no longer recognizes the virus as a threat, therefore not responding to infection or heightening immune system response. It is the same with FIV (Feline Immunodeficiency Virus). Felines in Africa live with the virus, but other cats infected with the virus without prior exposure progress to conditions that are the equivalent to AIDS.
The goal of HIV medicine is to put the infection to a point where it is stable, or where the patient can live with the infection. All this takes is a small shift of something in HIV. Part of the problem of finding this is the cost and difficulties especially in other countries that have a higher rate of infection and lower living conditions. Another problem is that most deaths are caused by secondary infections that attack the immune system when the disease has progressed to AIDS. The heightened immune response at the start of the infection later leads to rapid decline when the later stages of AIDS are reached, the immune system is weakened, and no longer has the ability to fight off secondary infections a healthy individual could survive.
Dr. Nemechek said that we need to look to the populations of Sooty Mangabeys that live with SIV (Simian Immunodeficiency Virus). These apes have a high viral load but their immune system doesn't recognize it so the system doesn't kick in. If SIV is injected into Rhesus Macaques, who have never been exposed to the virus, it progresses much in the same way that HIV does in humans. Evolution explains why the Sooty Mangabeys can live with SIV and the Rhesus Macaques cannot. The Rhesus Macaques have not had the evolutionary pressures that the Sooty Mangabeys have to develop a resistance to the virus. Over time the immune systems of the Sooty Mangabeys have developed in a way that it no longer recognizes the virus as a threat, therefore not responding to infection or heightening immune system response. It is the same with FIV (Feline Immunodeficiency Virus). Felines in Africa live with the virus, but other cats infected with the virus without prior exposure progress to conditions that are the equivalent to AIDS.
So to treat humans, "We may need to target immune systems to ignore it instead of target the virus." It can be as simple as a vaccine. "The smallest shift in some part of the disease process is all that is needed to dramatically change the time of death." If we could lower the rate of transmission by 25% there would be a huge impact on the epidemiology of the virus.
Finding a cure is a high mark; lower marks are more attainable.
Finding a cure is a high mark; lower marks are more attainable.
4) You just discussed how the immune systems in the primates of some regions have evolved to the point of no longer reacting to SIV. That said, do you think with the right amount of time, humans can evolve to the point where our immune systems will not react to HIV?
Theoretically yes. Humans have evolved against malaria with sickle cell.
Theoretically yes. Humans have evolved against malaria with sickle cell.
5) What do you know about grid-computing? Do you believe it would be effective in contributing to a cure for AIDS?
Dr. Nemechek said that he doesn't know enough. He knows that it is a way to speed up results and it is a very unique tool. Drugs can be designed on blueprint. They can be genetically designed for a weak spot on the bacteria. It takes massive amounts of computer technology to figure the molecular structure and with this structure drugs can be designed to target the weak spots.
Dr. Nemechek said that he doesn't know enough. He knows that it is a way to speed up results and it is a very unique tool. Drugs can be designed on blueprint. They can be genetically designed for a weak spot on the bacteria. It takes massive amounts of computer technology to figure the molecular structure and with this structure drugs can be designed to target the weak spots.
6) How long can HIV exist outside the body, if at all?
Just seconds to minutes until the source dries up.
Just seconds to minutes until the source dries up.
7) Why is AIDS considered a pandemic?
Dr. Nemechek said that is it considered a pandemic because it is affecting the whole world. It is one of the most powerful influencers of the economy and politics in the world. For example, in Africa HIV wiped out all of the gains that took decades to achieve in just ten years. It increased the secondary illnesses.
Dr. Nemechek said that is it considered a pandemic because it is affecting the whole world. It is one of the most powerful influencers of the economy and politics in the world. For example, in Africa HIV wiped out all of the gains that took decades to achieve in just ten years. It increased the secondary illnesses.
8) Is there any evidence for how long HIV has been around?
SIV is suspected to have been around for thousands of years. This explains the evolutionary development of immune response resistance to the virus in the Sooty Mangabeys as enough time has passed for this resistance to develop. HIV is a much younger infection and is believed to have been around for a couple hundred of years. There is documented evidence of specimens with HIV from the 1930's but it is expected that it has been around for much longer. There is evidence of HIV existing in Africa before the pandemic swept the world in an infection known as Slim Disease. In retrospect we can now recognize it to have been the HIV wasting syndrome, what is now recognized as the final stages of AIDS. It has only recently swept the world because needle transmission was nonexistent and travel was limited. As as result, exposure was likely isolated to just a single family or small community. Once that group of infected individuals died, so did the possibility for transmission and infection.
SIV is suspected to have been around for thousands of years. This explains the evolutionary development of immune response resistance to the virus in the Sooty Mangabeys as enough time has passed for this resistance to develop. HIV is a much younger infection and is believed to have been around for a couple hundred of years. There is documented evidence of specimens with HIV from the 1930's but it is expected that it has been around for much longer. There is evidence of HIV existing in Africa before the pandemic swept the world in an infection known as Slim Disease. In retrospect we can now recognize it to have been the HIV wasting syndrome, what is now recognized as the final stages of AIDS. It has only recently swept the world because needle transmission was nonexistent and travel was limited. As as result, exposure was likely isolated to just a single family or small community. Once that group of infected individuals died, so did the possibility for transmission and infection.
9) Are there any misconceptions about HIV/AIDS?
One of the biggest misconceptions of HIV is how SIV crossed species to develop in humans. Many individuals suspect it is from having sex with infected primate species. This is not correct. It was actually transmitted by eating the apes that were infected with SIV. In many of the open air markets the blood is not contained and there is very little disinfection. As a result, blood transmission is easily possible and consumption of infected animals or cross-blood contamination is the true source of the species jump from SIV to HIV.
We'd like to give a special thanks to Dr. Nemechek for sharing all this valuable information with us and showing us around the facility. The time was greatly appreciated.
- Kelsey and Amber
Again, what a fantastic job! My only question is whether you asked Dr. Nemechek if he would like to sign the waiver prior to the interview. Please let me know. At this point, I have you guys at a 30 out of 30 for the interview.
ReplyDeleteYour next step will be to read the articles posted specifically for your group on WebCT under "Service Learning." There are also questions concerning these readings, and your next blog entry will be comprised of answers to these questions.
Dr. Walker