Greek Journalist Lambros Papontoniou Corners US Presidential AIDS Coordinator Mark Dybul

MARK DYBUL: I would be happy to answer any questions.

STAFF: Please identify yourself and your affiliation.

Q Lambros Papantoniou, Greek correspondent for the Greek daily newspaper, Elettheros Typos, Athens. Ambassador Dybul, have you seen the HIV virus in a laboratory?

MR. DYBUL: I’ve seen – under a microscope, yes, I’ve seen electron micrographs of the virus, yes.

Q Where and when?

MR. DYBUL: Oh, they’re all over the place. They’re published in virtually ever journal. I have a picture of one in my office.

Q Do you have to report any progress on cure of this deadly disease?

MR. DYBUL: Unfortunately not. Cure is a word we don’t use in HIV/AIDS. We use treatment, life-long treatment. Like many diseases, chronic diseases, we’re not able to cure, whether it’s diabetes, hypertension. This is a chronic infectious disease which we can treat. We hope life-long; we don’t know for sure yet, but we hope life-long so that people live normal life spans. And in the clinics I actually still attend up at our National Institutes of Health, we’re actually dealing with regular diseases now as people are living very long times, 10, 15 years with antiretroviral therapy, but we don’t have a cure.

When we have a cure for HIV, it is quite likely that we’ll cure cancer, because HIV is a retrovirus that puts itself into the – our own human cells. Many infectious diseases live outside of cells and so we can get – access them relatively easily. To get rid of HIV, you actually have to kill human cells, much like cancer. So when we cure HIV and when we – we will, at some point, have such a scientific advance – we’ll be able to cure a lot of other things as well.

Q Ambassador Dybul, how do you allow U.S. doctors to prescribe the AIDS deadly medication since they never saw the HIV virus, as you saw as you told us earlier, but only in pictures in the Internet?

MR. DYBUL: The reason we can do it is the evidence are overwhelming that HIV exists. We have pictures, we have budding virus, we have the virus itself. We know what it’s inner workings look through crystallography. There’s a lot of things we can’t see under a microscope that we – a standard microscope, you have to use high-powered technology. You need technological advances to see it. But we can see it. The data are overwhelming that it’s transmissible and the data are overwhelming that drugs that interfere with its replication lead to healthy patients. So from every standard of clinical medicine, it would be immoral to not use it.

Q And the next one. How is your cooperation with South Africa, since President Mbeki is rejecting the drug therapies there.

MR. DYBUL: Well, that’s actually a myth. This year, South Africa – the South Africa government will dedicate in the neighborhood of $800 million to fight HIV/AIDS. We – they are supporting – the South Africa public health sectors has the largest antiretroviral program in the developing world, over 250,000, last time I saw, people receiving antiretroviral therapy at the direction of the government of South Africa. We support the efforts of the South Africans, not only the government but in the nongovernmental sector. And they have rapidly expanding – expanded services in the last several years.

Q Otherwise, do you communicate direct with the President Mbeki?

MR. DYBUL: Well, you know, I’m at the level of an assistant secretary of state, so I don’t talk to President Mbeke. But I do meet with the minister of health; I meet with presidents in other countries. South Africa’s a big government and he has a lot of responsibilities. But we do meet regularly with many of the secretaries or ministers in South Africa and many of the deputy ministers at their regional, provincial and all other levels. And we see great commitment on the part of many of these people to combatting HIV/AIDS.

STAFF: Thank you. One more question?

Q I thought somebody else would like to ask. May I ask two more questions? It’s very important.

STAFF: Sure.

Q Ambassador Dybul, do you know how many infected persons in the United States have taken the medications, stopped them later, and they are living today? Give us your data.

MR. DYBUL: I don’t know.

We do actually have data on people who have stopped drugs. And there are actually two randomized controlled trials that looked at, and this is another reason it’s clear that HIV/AIDS is causing all these deaths and sickness. I actually did some of this work myself at NIH, where we thought for a while if we stopped antiretroviral therapy, we could actually stimulate the immune system.

So a randomized controlled trial was done to do just this. And what they found is that there were so many more deaths in the stop arm that they had to stop the study and put everyone back on therapy. So that was one randomized controlled trial. There are several others that I’ve conducted myself that showed morbidity and death as a result of stopping drugs.

Q And the last one, Ambassador Dybul, do you know how many infected persons in the U.S. never have taken the medications, and they are living today, from the 1980s up to the present?

MR. DYBUL: Yeah, there are very few.

You know, almost all diseases are a bell curve – infectious diseases, where on the ends, people die or never get disease, and the everyone’s in the middle. This disease is actually unique in that less than one percent of people who have been documented to be infected do not get sick or die over a 10-20-year period, which is the course of this disease. It’s a chronic infectious disease.

So this is actually more deadly and atypical than almost any other disease. And the reason is, it actually attacks the immune system. It attacks and destroys the system that’s designed to keep it from killing you. And so this disease actually kills at a slower rate but kills at the rate of an Ebola virus, or another very aggressive type of disease, because so few people can protect themselves against it, because it destroys the very system that’s supposed to keep you alive.

Q Thank you, Ambassador.

MR. DYBUL: Thank you.

Copyright © Alberta Reappraising AIDS Society, Thursday, October 4, 2007.