The Pope, Condoms and the Evolution of HIV

[Enjoy the additional Pope/condom images as light Friday entertainment from IRMA...]

From The Lancet Infectious Diseases, Volume 9, Issue 8, Pages 461 - 462, August 2009.

Samuel Ponce de Leon, et al.

The unjustifiable nature of the Vatican’s opposition to condoms in the face of the spread of HIV has been underlined by many.1 Moreover, the claims made by Pope Benedict XVI during his recent trip to Africa that the AIDS epidemic is a tragedy that “cannot be overcome through the distribution of condoms; on the contrary, they increase it”2 reveal, among other issues, a very poor under standing of the evolutionary future of HIV and the emergence of new strains.

The epidemic has led to the development of highly eff ective therapies based on new antiretroviral drugs, which unfortunately are not available to most African patients. These new treatments have been developed with little consideration of their evolutionary consequences, but HIV will not cease to evolve, as shown by the rapid resistance developed against the different combinations of drugs that are being used.3 Clinical data show that in some parts of Europe and the Americas one of every ten newly infected people has an HIV strain that is already resistant to one or more groups of antiretrovirals.4,5 Unfortunately, the list now includes primary infections in which multidrug-resistant HIV subtypes have been reported.6,7 The unavoidable conclusion is that sooner or later we will observe resistance to even the most efficient combinations of antiretrovirals, with all the clinical and epidemiological adverse consequences.8 Even if we are able to overcome the problems faced in the development of vaccines, they will not be 100% effective.

By contrast, condoms, by their very nature, stop infections but do not act as a selective agent. Pope Benedict XVI, together with physicians, policy makers, religious organisations, and, eventually, the population at large, should become fully aware of the obvious: by acting as a purely physical barrier, condoms not only have a key role in limiting the HIV pandemic, but also help to keep down the number of new strains.

The Vatican must understand that, in purely darwinian terms, HIV will never evolve resistance to condoms.

1 The Lancet. Condoms and the Vatican. Lancet 2008; 367: 1550.
2 The Lancet. Redemption for the Pope? Lancet 2009; 373: 1054.
3 Kantor R, Katzenstein DA, Efron B, et al. Impact of HIV-1 subtype and antiretroviral therapy on protease and reverse transcriptase genotype: results of a global collaboration. PLoS Med 2005; 24: e112.
4 Booth CL, Geretti AM. Prevalence and determinants of transmitted antiretroviral drug resistance in HIV-1 infection. J Antimicrobial Chemother 2007; 59: 1047–56.
5 Vercauteren J, Derdelinckx I, Sasse A, et al. Prevalence and epidemiology of HIV type 1 drug resistance among newly diagnosed therapy-naive patients in Belgium from 2003 to 2006. AIDS Res Hum Retroviruses 2008; 24: 355–62.
6 Blick G, Kagan RM, Coakley E, et al. The probable source of both the primary multidrug-resistant (MDR) HIV-1 strain found in a patient with rapid progression to AIDS and a second recombinant MDR strain found in a chronically HIV-1-infected patient. J Infect Dis 2007; 195: 1250–59.
7 Delaugerre C, Marcelin AG, Soulié C, et al. Transmission of multidrugresistant HIV-1: 5 years of immunological and virological survey. AIDS 2007; 21: 1365–67.
8 Hogg RS, Bangsberg DR, Lima VD, et al. Emergence of drug resistance is associated with an increased risk of death among patients fi rst starting HAART. Plos Med 2006; 3: 1570–78.