Unshelved by Bill Barnes and Gene Ambaum
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Tuesday, December 16, 2003

Who says history isn't important? A key to a medical mystery...

With my interest in history in medicine, I was intrigued when I picked up this month's issue of AJN (The American Journal of Nursing) and found an article discussing the possibility of the Black Death (the mid-14th-century epidemic of bubonic plague that swept through Europe) may have caused a mutated gene (CCR5-delta32) that may confer partial resistance to HIV in affected populations. The CCR5 gene is important in that it acts a a sort of gateway into the cell for the virus to replicate and spread. The article, which is basically a summary of this research, doesn't appear to be online at Nursing World yet, but you may want to check back or better yet, check your local library for a copy. The citation is:
Goldrick BA. Emerging infections: bubonic plague and HIV--the delta32 connection. AJN. 2003 Dec;103 (1):26-27.

This may partly explain why, for example, Africans, American Indians, and Asians seem to progress quicker into full-blown AIDS than some of European descent--something that has led to allegations of a virus genetically engineered to wipe out people of colour. As a result of the studies done on this, research is being done to create drugs that can mimic the effects of this mutation as a way to help boost resistance to HIV replication in those who may not have the mutation.

The most important thing, of course, is looking at the mutation and how it works to keep HIV at bay. But the history of the mutation can help us understand the body's response to disease and also predict which specific populations are most at risk.

Of course, the bubonic plague theory is just that: it's a theory. I did a little checking and a recent article seems to indicate smallpox as the main catalyst for mutation, rather than plague. That may mean a wider population may have partial resistance to HIV, since most areas colonised by Europeans encountered smallpox.

I would be interested in, say, how the people of Bangladesh, where plague has been endemic for thousands of years, would come out on the gene mutation. Of course, there were several waves of plague that hit parts of Europe (one may have hit Athens during the Peloponnesian War), but it seems this mutation may have specifically been triggered by the widespread epidemic of 1347-48.

It would seem to me that eventually you could check an HIV patient for that mutation and it might affect decisions in terms of course of treatment. Perhaps those with the mutation would not need quite the same cocktail mix of (let's face it, pretty powerful and toxic) drugs than someone who didn't. Or, hopefully, we will have drugs that can mimic its effects soon, and push those early on people who don't have the mutation. In America, where we have such a genetic melting pot, you can't just rely on apparent race, but each person treated as an individual. In some more homogenous genetic areas, it might mean a difference in widespread treatment. Of course, it's just one piece of the puzzle. But still...hopefully it will help.

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