Nuances

Have you ever heard a doctor, advocate or friend say "you probably know someone living with HIV and you just don't know it"? People hiding in plain sight. I've said that to people. It's a way to get them to consider HIV in a way they never have before. To humanize the scary HIV acronym and make them think about the nuances of what it must be like to live with it.

The 2022 CROI conference did that for me in an unexpected way this year. Humanized science when science isn't exactly popular for having human qualities. Not to mention the challenge of yet another virtual conference platform. Arguably it's the biggest science conference in the HIV realm. I went into it thinking I was going to play a scientist. Not. I found myself overawed and baffled wondering what I had gotten myself into. At first; then I took a breath and remembered it's not my job or purpose to know it all. My job is to learn what I can, then use that knowledge to help someone. Plus, I remembered I could press pause and rewind as many times as I needed to from my computer screen, and Google and Bing are my friends! LOL!

Back to my point. CROI is an acronym for Conference on Retroviruses and Opportunistic Infections. HIV is a retrovirus. A retrovirus inserts a copy of its RNA genome into the DNA of a host cell that it invades, thus changing the genome of that cell. Opportunistic infections (OIs) are pretty much what they sound like: an infection that takes the opportunity to infect a host (human). There is a pretty big list of OIs – most of which you've likely never heard of. In simple terms, anyone can get infections such as herpes and pneumonia or even more serious infections such as lymphomas or toxoplasmosis. In the presence of untreated HIV, these can be life-threatening illnesses with complications stemming from the combination of HIV and the infection itself – more so than in the general population. We know about these because of years of HIV research. CROI was started as a way for researchers, clinicians, and scientists to exchange information and keep each other aware of advancements. CROI additionally addresses topics like hepatitis, other viral infections, and of course this year a hot topic was SARS-CoV-2 – a coronavirus that causes what we now call COVID-19.

The day-to-day of living with the virus and working on the virus may be different, but determination and human spirit keep each person going and linked.

None of this is sounding humanized yet huh? Sorry. Here's the human part. These are people working behind their acronym of CROI to help humanize the science part of HIV! Not only that but these very same "science-y" people get nuances. When I tell you, I learned about things I would not have thought about on my own, that's a truth. For example, I listened to a session on pregnancy, infants and children. For most people, the big picture is making sure pregnant women living with HIV are undetectable so their baby can be born negative. Seems pretty straightforward, right? Let me blow your mind really quick- it's estimated that there are 15 million people who have been exposed (in utero – or in the womb) to HIV but did not acquire it! HEU: HIV exposed but "uninfected." Wild, right? Exciting on its own, right?

Consider these nuances though: Researchers study things like infant into adolescent neurocognitive health, how these young people grow physically, the effects of the medications that they take in early life (and in utero) to prevent them from becoming HIV-positive. I could go on and on. There were sessions on HIV cure research and new prevention modalities in the pipeline. New long-term treatment options. There was a discussion about the first woman, and third person, who potentially is on the path to being cured and what that may mean for future cures. A discussion on long COVID and the implications into the older person's life. These are just some of the topics of talks and abstracts (both oral and poster) presented at the conference. I'll write about a few of these separately, but this is what I mean by considering things in a way you haven't before.

Basic science in virology and pathogenesis … clinical science in things like medications and cardiovascular effects of COVID … epidemiology and public health … subjects like testing and prevention … All of these topics and so much more, presented by people who may work in a separate clinical space filled with graphs and confounders and ratios, yet are interconnected with the people living with these conditions day to day. I see the connection as hope on both sides, no matter what the motivator is. The researcher may be hoping to come up with the cure for very different reasons than the person living with HIV, but they both want a cure. The day-to-day of living with the virus and working on the virus may be different, but determination and human spirit keep each person going and linked.

Science is pretty straightforward until you consider the people working in it and the people they work to help. Nuances.