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AIDS And The Black Death

I keep reading about leaps forward in the treatment of HIV and AIDS so I figure if I want to mention this, I better do it soon or may be a moot point. First, I want to add a disclaimer right at the beginning that I am not advocating stopping the treatment of those with AIDS, nor doing anything else with them except treating them.

What if we didn’t treat AIDS? It’s a good question, because we try and treat everyone, but what if we didn’t.

There is a term, and I forget what it is, for the level of new infections a disease needs to continue to propagate itself. If the number of new infections falls below this level, the disease dies out, (more or less) if the number rises above this level, the disease spreads and grows. Non-treatment of a disease has been tried before as a means of eradicating it, albeit in unintentionally. Let me give you an example.

The Black Death. We haven’t the foggiest what it actually was. The leading possibility is, and has been for a while, bubonic plague. There isn’t really any great evidence for this (direct evidence like DNA or other “fool proof” evidence), other than the indirect kind, such as comparing signs and symptoms documented to known diseases today. Obviously the problem with that is if the disease doesn’t exist today, than we will never be able to compare, now will we?

At any rate, the black plague just kind of stopped, it disappeared on it’s own after wiping out somewhere between 30% and 50% of the population of the earth, poof, gone. Why?

There are lots of possibilities, the one I favor is that population and the density of it, had declined so much that the disease couldn’t spread fast enough to sustain itself. It was a relatively quick killer you see, and unlike TB or AIDS you were not at all mobile after coming down with it, further reducing the possibility of transmission to others. It’s not hard to imagine that with literally every other person dead the disease ended up dieing with them. There is also the issue of immunity* (interestingly, one does not gain immunity from the bubonic plague if you survive it), those who got the disease and survived, never seemed to get it again, often their issue never fell victim to the plague. That means that once it killed everyone susceptible to it, who else was it going to infect?

The way this fits in with AIDS is that the life expectancy without treatment is usually less than a year, while the life expectancy with good treatment is 20 years or more, even with crappy treatment, it can be 9-11 years, according to Wikipedia. So, what if we stopped treating AIDS and HIV?

Like the black death, it might be that those infected died so quickly, that the number of times the disease could be passed on falls dramatically. The question I’m asking is whether that decline in infections would be so high, that the disease is unable to sustain itself. The most effective prevention technique might be not treating the disease, at least from the standpoint of preventing future infections. Again, I’m not advocating this, it’s not acceptable to me, even if it would wipe out the disease.

*Immunity to the black death is supposedly expressed in a gene which may also confer immunity to small pox and limited immunity to HIV. I happen to be the lucky owner of this mutation, which I wouldn’t know, except that my sister was born with a rare immune deficiency and both of us were subjected to test after test after test when we were younger. Both of us being descendents of people from northern Europe, Ireland mostly, we both had a chance of having the gene and being awesome, but I won and science says I am 900% more awesome because of it.

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