Ricky Gervais: AIDS vs Rabies

I dont know why he took it down, but Ricky Gervais Tweeted the following a few days ago:

Any virologists or medical experts out there? What WOULD win out of AIDS & Rabies?

Maybe he took it down because he thought it was insensitive or something, but I think its a totally normal, valid question for a layman to have!

What WOULD win out of AIDS & Rabies steel-cage death-match????


First, a clarification. AIDS is the syndrome caused by infection by HIV-1.  HIV-1 is the virus, not AIDS :)

Who would win in an HIV-1 vs rabies battle depends on how they are 'battling', and what signifies a 'win'.  A common misconception that laymen have (which I talked about on Skeptiles!) is that The Best virus kills more people, faster.  That is not the case at all!  Think about the title of this blog: ERV.  Endogenous retroviruses have infected every human on this planet (several times over, to the point where ERVs constitute ~8% of the human genome) but they arent killing everyone.  The virus survives if we survive to propagate. Almost 7 billion infected.

Contrast that with a virus like ebola. It certainly kills people relatively quickly, but that means it burns out before it can be passed to the next victim. Since it was identified in 1976, there have only been a couple thousand diagnosed ebola infections.

Which is the 'better' virus? 7 billion vs a touch over 2,000?

I would argue that its the viruses that dont make us really sick, the ones that are more discreet and silently pass from one human to the next, that are 'better' than the viruses that mindlessly consume their host, burning out before they can be transmitted to a new one. In fact that appears to be the trend with SIV, the virus that gave rise to HIV.  African primates have been infected with SIV for tens of thousands of years. Over that time-frame, SIVs that killed primates too quickly were selected against, primates that could tolerate SIV infection better were selected for. The end result is that SIV in its natural hosts, African primates, is relatively non-pathogenic. What evolved was not a super-pathogenic-kill-ALL-the-monkeys SIV. The opposite happened.


But what would win in an HIV vs Rabies battle? The tortoise or the hare? We will have to look at this viral battle from lots of angles--

HIV-1 is a sick-and-stick virus.  Like the herpes viruses (chicken pox, mono, HSV-1 and 2), once you are infected, you are infected for life. The complications of the infection are not immediately deadly/drastic so you can spread the virus allllllllll around to the people you interact with.  Which means from that one zoonotic event (chimpanzee-->human, HIV-1 Group M), there are now 34 million people infected with HIV. A few million new infections every year, a couple million deaths/year.

We do *not* have an HIV-1 vaccine.

We *do* have effective anti-HIV drugs.

Rabies, on the other hand, is deadly, and relatively quickly (1-3 months, not like, hours-couple days-- viruses arent as 'fast' as people think). It cannot be transmitted human-to-human, so humans are an 'accident', a dead-end host.  But that doesnt help the 55,000 people who die from rabies infections every year, because there is no human vaccine or anti-rabies drugs.

However, we *do* have an effective rabies vaccine for dogs, the source of most human infections, so human rabies infections are going down.

We also *do* have effective prophylactic rabies exposure treatments. If you suspect you have been bitten by a rabid animal, immediate treatment is wonderfully successful.  If you dont know you are infected and are subsequently diagnosed after you drop into a coma, all isnt lost either.

But those post-exposure treatments and those dog vaccines are a luxury of the West. Those 55,000 human rabies deaths happen in parts of the world where they cannot afford the necessary prevention and treatment (Africa, Asia).  Dog rabies and human rabies deaths *can* be prevented.

... So who is the winner???

Ohhhhhhhhhhhhhhhhh!  Thats what he meant! "HIV vs Rabies, if they met in the blood?"

Well, this will be anticlimactic... They wouldnt even fight. They would both just float there, staring at each other, saying 'Hey dude, have you seen a CD4+ T-cell?' 'Naw man, have you seen an acetylcholine receptor? I kinda need one. No? Thats cool.' *stare* *stare* *blink*

Eventually they would either go their separate ways and find their respective target cells, or they would just fall apart and that would be that.

Worst steel-cage death-match ever :-/


But I dont want to end on a bum note, so, here is a bonus:

"Could you give AIDS cancer?"

We cant give AIDS cancer, but we can give cancer HIV!  Viruses, including HIV, have all kinds of fun therapeutic potential! Pitting bad-guy-vs-bad-guy, HIV vs Rabies, Cancer vs HIV-- Gervias might have meant it as a joke, or a joke/serious question, but its actually a really good idea! A really good idea that scientists are actively pursuing.

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It should be noted that there is a human rabies vaccine as well. Veterinarians among others who are likely to get bitten get the vaccine. I suspect that spelunkers as well should get it as bats often carry rabies also. For most folks the vaccine is not needed as the risk is sufficiently small, that the risks and costs exceed the benefit. The CDC site has more details on who should get the vaccine:http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-rabies.pdf

I'm confused. I thought that during the later stages of rabies in humans that the virus was being shed and that it could be past (end stage rabies victim bites a nurse, etc).

First! (belated)

Cool stuff.
Giving HIV cancer seems like airplane travel by picking up the aircraft and jumping to the destination.

"But that doesnt help the 55,000 people who die from rabies infections every year, because there is no human vaccine or anti-rabies drugs."

Actually, to continue with what Lyle had posted, there are indeed rabies vaccines which are administered to humans.

http://www.cdc.gov/rabies/medical_care/index.html Even the CDC lists them.

By badrabbit007 (not verified) on 08 Feb 2013 #permalink

Quite right-- I should have been more precise. There are vaccines that we 'have', but Average Joe/Jane arent usually going to get them. Only particular people in particular situations, not like, for instance, a polio vaccine everyone gets when they are little, or a flu vaccine you can get every year. I dont believe travelers are generally required to get the rabies vaccine when they are going places it is causing problems (unlike, for instance, yellow fever).

I actually have no clue why it is so non-standard, even in the places that need it. It doesnt appear to be as problematic as say, the anthrax vaccine, so Im assuming it is not utilized in the places rabies is still active due to its cost.

It could be that it's not mass produced because A) the areas that could afford the vaccine don't have as many rabies incidences as B) opposed to areas that have a higher rate of rabies incidences but can't afford the vaccine.

Like you said above, due to cost. There was also a shortage not long ago. However, there is a campaign to vaccinate dogs in third world countries.

So... They make vaccines readily available to dogs en masse but not humans? I guess preventive measures are better, but that just may be because vaccines for animals are cheaper.

By badrabbit007 (not verified) on 08 Feb 2013 #permalink

Hmmm...which would win...easy...AIDS.
Which is a person more likely to do:
A) Get bite by a rabid animal
B) Have sex with a human

B of course, AIDS WINS.
See easy...don't over think comedy.

By Gregg R. Thomas (not verified) on 09 Feb 2013 #permalink

I'm pretty sure I got a rabies vaccine when I was a child. It must have worn off by now, but it certainly does exist. I'm also sure that when traveling into certain countries, like East Asia, it is recommended to get the vaccine shot.
Also, there was recently a case in the news where an organ donor caught rabies on a trip to Asia shortly before she died in a traffic accident before it could break out and she subsequently infected everybody who got her organs, most of whom died. When it was in the news, they talked about the vaccine and that even if you didn't get the shot beforehand, that same vaccine is also the best treatment after getting infected, IF you administer it in time.

Even though Gervias meant what would happen if rabies and HIV met in the blood, I think he still left the interesting question behind of which is more dangerous to humans. Even though rabies has became dangerous in third world countries I still do not see it as a threat becuase it cannot be passed from human to human. HIV on the other can. Out of the two it is the slower killer but it makes us unable to reproduce. Not only can it be spread to a partner but a fetus can contract it from its mother. I think this mainly what ,makes this virus dangerous to the human race. If too many people get it and our not able to reproduce it can really eliminate a large part of out population. This is very unlikely of course unless it is developed into a warfare strategy to eliminate an enemy.

Very interesting topic, thanks for posting.

By SexyMarlin (not verified) on 11 Feb 2013 #permalink

The preventative rabies vaccine schedule has a lot of injections: 3 initial injections over three weeks, followed by a booster every two years if you expect only incidental contact - Those that work with the live virus are expected to get a booster every six months. Meanwhile, while not severe, the side effects are too common for comfort - It's probably hard to get compliance, especially in an area where going to the doctor often isn't part of the local culture.

Since you can use the vaccine and the immune globin as a post-exposure treatment successfully, and exposure usually has an obvious event correlated with it, we mostly have an issue of getting people in for treatment and paying for it once, before the onset of the disease, rather than every single person in a hot spot. Getting that event recognized and bitten or scratched people in for treatment is the hard part, especially where bats are involved.

If I may--a couple minor corrections, Orakio. As a veterinarian (and vaccinee) with strong public health interests, I'm tuned into this issue, so this blog post jumped out at me. The recommendation that anyone with only incidental contact (which covers practically all of us veterinarian types, even in areas of enzootic status) get a booster like clockwork every two years went by the wayside a long time ago. CDC's current recommendation (repeated in the most recent MMWR update on the topic: MMWR RR-3, vol 57, 23 May 2008) is that anyone in the "frequent" risk category, defined as "exposure usually episodic, with source recognized, but exposure also might be unrecognized. Bite, non-bite or aerosol exposure", should have serologic testing done every two years, boostering only if antibody titer is below acceptable level" (< 1:5 on the RFFIT). For those in the "infrequent" risk category, the recommendation is vaccination only, with no serologic testing or boosters. But, given the serious implications of an exposure, most people don't hair-split whether they work in an enzootic area or an area where rabies is uncommon or rare, so regular serologic testing is recommended, at least for veterinarians.

Even in the "continuous" (read highest) risk category, comprising rabies research lab workers and rabies biologic production workers, CDC's recommendation is almost the same as for those in the "frequent" risk category: primary vaccine series, more frequent serologic testing (every 6 months) and booster vaccination only if titer falls below 1:5.

FWIW, nearly 30 years after receiving the primary series as a student, my titer (checked a little less often than every two years--more like every 4-6) has never fallen below 1:5. if it does, booster time; otherwise, no.

This is why I love blogging :-D Im learning stuff, readers are learning stuff, all because of a 'stupid' question from Gervais. I wish more people would pipe up about their 'stupid' questions!

On the subject of the rabies virus, you stated:
"It cannot be transmitted human-to-human, so humans are an ‘accident’, a dead-end host."

I've heard that the rabies virus is the origin of the vampire mythology. Afraid of light, retreat, rabids try to bite people, and their vic5tims join team vampire. Fairly common in mammal mythology, and explains the bat connection.

Is it true that humans do not carry the virus in their saliva and are not enticed by the virus to bite? Are our dog friends actually seduced by rabies to bite, or is that just a side effect of being really pissed off because they are crazy, and that's what dogs do? They bite.

Dumb question #500

Thanks for the clarifications, BG. :) I just has the google to help me along most of the time.

Also, was the original Roux / Pasteur vaccine schedule a lot more brutal in terms of number of injections and rigorousness? I seem to think it was, but that may be misinformation I was fed somewhere - but even a reputation of difficulty in the vaccination schedule is going to affect public health decisions when they get made by legislative bodies with imperfect information.

Oh, no worries about asking dumb questions! I truly believe that old saying (not sure who gets credit for it)--the only dumb question is the one that doesn't get asked.

Scooter (#16): On the myth of humans not shedding rabies virus in saliva--it's a myth, absolutely. Humans who have progressed to the stage of showing clinical signs and symptoms of rabies most certainly DO shed virus in their saliva, although the titer (level) is much lower than in dogs. This is probably why human-to-human transmission through saliva contact has never been documented, even before the advent of infection-control procedures. Regardless of the lower virus titer, barrier protection (goggles, mask, gown, gloves) is standard in the care of people with rabies infection in hospital settings. Several studies have documented shedding of virus in pharyngeal secretions, which includes saliva; tears and CSF; blood, urine and stool are not considered sources, but it's a moot point because barrier protection will be used in treating these patients, whether or not blood exposure is a risk factor.

As to why dogs bite, it's not because they're POed or "seduced"; the infection, once it reaches the brain, progresses through three stages: prodromal, furious and paralytic, and these represent progressive worsening of the encephalitis (brain inflammation) caused by the infection. Rabid animals pass through these phases, but for reasons that aren't completely understood, they don't do so identically (for example, rabid bats don't go on rampages, biting everything they encounter--they progress quickly to the paralytic stage and lose their ability to fly normally). Rabid cattle, horses, dogs, wolves, etc. in the furious stage are truly terrifying--this is where the legends arose. People with rabies (it's not a pretty way to die, btw) show variable symptoms as well, some spending longer in the furious (it's more like agitated) stage, others longer in the paralytic stage, but regardless, people with rabies don't show the level of aggression, including biting, seen in animals. They will thrash around a lot, and are very agitated and probably combative, so I suppose biting might be a part of that behavior, but in all the references I've ever read about rabies in people, biting has never been mentioned. (And in a hospital setting, that agitation can be managed with medication.)

Orakio (#17): "Brutal" is a very good word to describe Pasteur's original vaccine protocol--upwards of 10 immunizations (the kid he saved with his first trial got 13, I think)--involved intraperitoneal injections of a spinal-cord derived vaccine. it's definitely not done this way any more, but you would not believe how many people--who have no science background at all--somehow know about that. The misguided belief that that's what happens to someone who gets exposed to a rabid animal--you get "a dozen painful shots in your stomach"--simply will not go away. I can't tell you how many dozens of times I've heard that over the years. Every time there's a story in the news about a rabid animal, some newscaster utters the phrase "painful rabies shots" and I think "here we go again." Rabies vaccines given today are given by the IM route in the arm, and they're no more painful than influenza vaccinations, but the myth persists.

End of sermon... hope this was helpful!

BG (#18):

It looks to me like Imovax and RabAvert are relative newcomers. So, the basic the problem looks to be that no one remembers going to the hospital or whereever for three shots after being bitten by a dog, just that they had to go back a couple times. And that was one scary chihuahua. Meanwhile, grampa certainly does remember the time when Uncle Bob got bitten by a stray in Basic Training in 1943, had to hit the Pasteur routine, and it's his faaaaavorite story. So it's not so much reality as it is a cultural memory. It'll fade out eventually, but it'll take a while.