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Infectious Diseases: Many Gains, Much To Do

One new challenge is the disproportionate infection of new HIV infection in young women. “A 17-year-old is often quite taken by a college freshman 5 to 6 years older than them. Young men who don’t know they are HIV-positive infect 16- to 17-year-old young women who do not know they are HIV-positive and go on to infect their 20-year-old partner,” described Deborah Birx, MD, ambassador-at-large, State Department, in her talk.
PEPFAR has shifted its focus from the very young to people of various ages in target regions. In Kenya, for example, new infections were nearly the same in number among children and adults in 2000. By 2015, however, the numbers had shifted overwhelmingly to adults older than 35 years. Convincing this population, particularly young men, of the need for testing and care is paramount.
“We have had tremendous success after 20 years of antiretroviral therapy. Over 17 million people were on life-saving therapy in 2015. But our work is far from done. As we are here this week at this meeting, over 2000 children and over 19,200 adults will die from HIV; over 2800 babies will be infected with HIV; and over 37,000 adults will be affected with HIV, with over 7500 being young women,” said Dr. Birx.
The past and future influence of microorganisms on infectious disease and the future of medicine were addressed by David Relman, MD, Stanford University School of Medicine. “We like to think that we command this universe. We really don’t at all. This is a microbial planet,” he said.
The bacterial world that has been discovered through sequencing of DNA recovered directly from the environment, rather than tried-and-true culture techniques, has revealed a world very different from that perceived 50 years ago. “It’s not a world of gram-positive, gram-negative, acid-fast, fungi, and other microbes, the way textbooks have been organized and some still are,” said Dr. Relman in his talk.

Big advances in treatment can