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Comment by codeflow2202 | Hacker News Reader

They should really make a vaccine against HIV. Oh wait: https://edition.cnn.com/2022/01/31/health/moderna-mrna-hiv-v...

HIV mutates so fast. I wouldn't get my hopes up.

As I understand the theory here is that humans develop antibodies against the parts that mutate making our immune system ineffective, while a vaccine could teach the immune system a better part to identify against.

Yeah but, is that because it gets a chance to mutate because there's no effective vaccine?

I'd think it'd just mutate into something that the vaccine isn't effective for.

New vaccines every year. Could be a big business.

The cure for HIV/AIDS has been one clinical trial away for >>30 years, now.

Don't believe the hype. Wait for results.

How many people are effectively managing the disease now who would have died 30 years ago? Perhaps you should be less glib out of respect for their lives.

You're responding to somebody mentioning that a cure has been announced as being immanent a dozen times, not somebody who is denouncing medicine in general. No need to attack unless you actually disagree.

It's not an attack to remember that medicine is about saving lives: changing HIV from a death sentence to a daily pill was _huge_ improvement for people and it feels quite weird to act as if nothing changed.

cure and treatment are two totally different things

They're different but not completely so: what I'd look at is the cost to someone's life. For example, glasses don't “cure” bad eyesight but they lower the impact down to the point where most people don't care. Type 1 diabetes used to be a death sentence, it's still uncurable and while it's not fun to have I know plenty of people would have died before graduating high school a century ago who are living normal lives, raising children, etc.

Similarly, when I was growing up HIV was a death sentence and it was tearing through many social groups. The gay friends I have, especially the slightly older ones, have talked about the trauma that caused because their social networks were decimated _and_ a lot of people blamed the suffering on them. Now, it's not ideal to be on medication but it means that people are reaching close to average longevity with far more manageable health impacts — again, not perfect but decades of extra time with friends and family is a transformative change.

This is totally uncalled for IMHO.

What about dismissing decades of hard work by many thousands of people as “hype”? There've been a lot of disappointments along the way but it's not like these were the people pushing Ivermectin as a COVID treatment — a ton of scientific careers have been spent working on this and it seems far too glib to brush that away as if there isn't a life-changingly better prognosis for someone who learned they were infected today compared to 30 years ago.

Don't believe the hype is a common expression in English. You are just reading much too much into it IMHO. And I don't like to see discussions derail into this.

If you're familiar with the expression, you're also familiar with it having a connotation of something being oversold, usually for reasons of sales or politics. I don't think that's a fair way to describe good faith scientific research into a hard problem.

You've had three, (now four) people explicitly mention that your comment was needlessly hostile. To each of those people, you've responded defensively.

I would suggest that you carefully review what was written, what you wrote, what the feedback from it was, and consider if there is room for improvement rather than just digging in.

Since your reply was cordial, I'll note that I probably would have used wording to make it more clear that I was specifically unimpressed by the use of terms like hype or what read as the implication that there's been a widespread representation that a cure is close. I've typically only seen that in the context of the various scam claims over the years, not mainstream research — the coverage I've read since at least the 90s always mentioned it as a very hard target a long time off.

Maybe I'm a bit biased from having worked at some places where researchers were working on problems like this but it felt unfair to focus on that but not mention that there are now mainstream treatments developed as part of that work which have made a huge improvement for millions of people globally.

> How many people are effectively managing the disease now who would have died 30 years ago? Perhaps you should be less glib out of respect for their lives.

I don't think the parent commenter was being glib. Treatments are great, but a treatment is not the same thing as a cure. Lots folks successfully treat their diabetes, but I'll bet most of them would prefer a cure for diabetes.

No question, but that doesn’t make science hype just because it didn’t produce a cure by the end of the episode. Just in case it wasn’t clear, I’m explicitly calling out that choice of wording. If they’d said “this is a notoriously hard problem”, I’d agree.

While PEP/PrEP is not a cure for HIV infection it both prevents AIDS and suppresses HIV so far that patients are no longer infectious. This solution is real, proven and available and is applied in practice right now. The only practical difference between this and a vaccine is that the user has to keep taking medication.

Could someone with more knowledge explain to me why a vaccine against HIV would not also be a cure?

If the body has antibodies against HIV so you can't get infected, it should also be possible to kill HIV as well when you are infected? Especially since the vaccine targets a structure which the normal immune protection normally doesn't target?

Protection from infection is sort of like cleaning up a spill on your doorstep. Curing an active infection is more like cleaning up after someone deliberately blew dirt throughout your whole house, and hid some extra in nooks and crannies.

A vaccine has the potential to give you enough of an immune response to prevent an infection. But eradicating an existing HIV infection is a very different problem. The virus lies dormant in large quantities, and your immune system will only attack the virus that’s “awake”. The current research for a cure is focusing on eliminating this viral reservoir. While your immune system could theoretically keep the active HIV at bay, leading to a functional cure; we’ve never seen this play out (other than in Timothy Ray Brown). HIV always wakes up, and replicates faster than your lymphocytes can kill it (while using your immune system as a virus factory).

Then they should require that that all newborns and their parents get it to be able to be seen by a healthcare professional. /saracasm

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