Four things you should know about the HIV "cure" before you get too excited

The baby might not even have been infected in the first place.

The story everyone is talking about today is the HIV "cure" - the Mississippi baby who, after being blasted with a cocktail of anti-viral drugs at birth, is now, at two years old, apparently virus-free. But when reading the euphoric news stories about it here, here and here, you should bear the following in mind:

1. The baby may not even have been infected in the first place

Here's a weird section in the NYT version of the story. Have a read of the following two paragraphs - are the doctors certain or uncertain that the baby was infected?

“The one uncertainty is really definitive evidence that the child was indeed infected,” said Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston.

Dr. Persaud and some other outside scientists said they were certain the baby — whose name and gender were not disclosed — had been infected. There were five positive tests in the baby’s first month of life — four for viral RNA and one for DNA. And once the treatment started, the virus levels in the baby’s blood declined in the pattern characteristic of infected patients.

The tests are pretty good, but are not usually trusted as a basis for confirmed diagnosis at that early stage. It is normal practice to confirm positive tests at 6 weeks. But as this baby had already been treated by then, lowering its viral load (negative tests came back at 29 days), it would have been difficult to do this. There is a very small chance the baby was not infected.

The virus may not have yet taken a hold on the baby's cells in a permanent way. Here's the WSJ:

Cells in the baby "may have been infected—there was virus around," said Steven Deeks, an AIDS researcher at University of California at San Francisco. "But the cells being infected weren't the type that become long-lived reservoirs."

There is also a small chance the baby was immune to HIV anyway. Around 1 per cent of Caucasians in the US are naturally immune.

Now, these are small chances, but then this baby is an outlier. It was not part of a large study where such anomalies are ruled out. The scientists have said it is unlikely to be replicable. Any way you put it, the baby itself is an anomaly.

2. This "cure" has already been found, and has been used on newly-infected people since 1987. Even if the baby was infected, today's news would simply extend it to newborns.

Today's news applies only to babies. Newborns at that. And it's not really a new method - rather, it's the same idea as PEP: if you have only just been infected, you might avoid HIV if you are immediately given a large amount of anti-HIV drugs. What the scientists confirmed today is that, in terms of emergency treatment, newborns are the same as newly-infected people. 

Here's the NYT again:

“That goes along with the concept that, if you treat before the virus has had an opportunity to establish a large reservoir and before it can destroy the immune system, there’s a chance you can withdraw therapy and have no virus,” said Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases.

(Oh, and if you were wondering, someone has actually been cured of AIDs before. This was a man called Timothy Brown, a leukemia sufferer who received a bone-marrow transplant from a donor genetically resistant to HIV.)

3. This would not be breaking much ground in preventing HIV in newborns anyway, because we have a solution for that

In countries with access to top-notch medical care (ie western countries), the transference of HIV from mother to child is extremely rare. This is because mothers are treated with antiretroviral therapy during pregnancy - a very effective way of preventing HIV in newborns.

4. Newborns in countries without a solution for that probably wouldn't get this treatment anyway

In countries without access to top-notch medical care, there is no reason that this treatment would be available where antiretroviral pregnancy treatment isn't.

So what does the news mean? Well it means that a few babies in countries with access to this sort of care but whose mothers have somehow slipped through the net of normal practice can be saved. Joyous news. But not quite as joyous as everyone seems to be making out.

UPDATE: This blog originally said that HIV tests at birth couldn't be accurate, but this applies only to antibody tests. The tests on DNA/RNA, which were done in this case, have a greater (although not 100 per cent) degree of accuracy.

HIV cure: not necessarily.. Photograph: Getty Images

Martha Gill writes the weekly Irrational Animals column. You can follow her on Twitter here: @Martha_Gill.

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The internet makes writing as innovative as speech

When a medium acquires new functions, it will need to be adapted by means of creating new forms.

Many articles on how the internet has changed language are like linguistic versions of the old Innovations catalogue, showcasing the latest strange and exciting products of our brave new digital culture: new words (“rickroll”); new uses of existing words (“trend” as a verb); abbreviations (smh, or “shaking my head”); and graphic devices (such as the much-hyped “new language” of emojis). Yet these formal innovations are merely surface (and in most cases ephemeral) manifestations of a deeper change a change in our relationship with the written word.

I first started to think about this at some point during the Noughties, after I noticed the odd behaviour of a friend’s teenage daughter. She was watching TV, alone and in silence, while her thumbs moved rapidly over the keys of her mobile phone. My friend explained that she was chatting with a classmate: they weren’t in the same physical space, but they were watching the same programme, and discussing it in a continuous exchange of text messages. What I found strange wasn’t the activity itself. As a teenage girl in the 1970s, I, too, was capable of chatting on the phone for hours to someone I’d spent all day with at school. The strange part was the medium: not spoken language, but written text.

In 1997, research conducted for British Telecom found that face-to-face speech accounted for 86 per cent of the average Briton’s communications, and telephone speech for 12 per cent. Outside education and the (white-collar or professional) workplace, most adults did little writing. Two decades later, it’s probably still true that most of us talk more than we write. But there’s no doubt we are making more use of writing, because so many of us now use it in our social interactions. We text, we tweet, we message, we Facebook; we have intense conversations and meaningful relationships with people we’ve never spoken to.

Writing was not designed to serve this purpose. Its original function was to store information in a form that did not depend on memory for its transmission and preservation. It acquired other functions, of the social kind, among others; but even in the days when “snail mail” was less snail-like (in large cities in the early 1900s there were five postal deliveries a day), “conversations” conducted by letter or postcard fell far short of the rapid back-and-forth that ­today’s technology makes possible.

When a medium acquires new functions, it will need to be adapted by means of creating new forms. Many online innovations are motivated by the need to make written language do a better job of two things in particular: communicating tone, and expressing individual or group identity. The rich resources speech offers for these purposes (such as accent, intonation, voice quality and, in face-to-face contexts, body language) are not reproducible in text-based communication. But users of digital media have found ways to exploit the resources that are specific to text, such as spelling, punctuation, font and spacing.

The creative use of textual resources started early on, with conventions such as capital letters to indicate shouting and the addition of smiley-face emoticons (the ancestors of emojis) to signal humorous or sarcastic intent, but over time it has become more nuanced and differentiated. To those in the know, a certain respelling (as in “smol” for “small”) or the omission of standard punctuation (such as the full stop at the end of a message) can say as much about the writer’s place in the virtual world as her accent would say about her location in the real one.

These newer conventions have gained traction in part because of the way the internet has developed. As older readers may recall, the internet was once conceptualised as an “information superhighway”, a vast and instantly accessible repository of useful stuff. But the highway was a one-way street: its users were imagined as consumers rather than producers. Web 2.0 changed that. Writers no longer needed permission to publish: they could start a blog, or write fan fiction, without having to get past the established gatekeepers, editors and publishers. And this also freed them to deviate from the linguistic norms that were strictly enforced in print – to experiment or play with grammar, spelling and punctuation.

Inevitably, this has prompted complaints that new digital media have caused literacy standards to plummet. That is wide of the mark: it’s not that standards have fallen, it’s more that in the past we rarely saw writing in the public domain that hadn’t been edited to meet certain standards. In the past, almost all linguistic innovation (the main exception being formal or technical vocabulary) originated in speech and appeared in print much later. But now we are seeing traffic in the opposite direction.

Might all this be a passing phase? It has been suggested that as the technology improves, many text-based forms of online communication will revert to their more “natural” medium: speech. In some cases this seems plausible (in a few it’s already happening). But there are reasons to think that speech will not supplant text in all the new domains that writing has conquered.

Consider my friend’s daughter and her classmate, who chose to text when they could have used their phones to talk. This choice reflected their desire for privacy: your mother can’t listen to a text-based conversation. Or consider the use of texting to perform what politeness theorists call “face-threatening acts”, such as sacking an employee or ending an intimate relationship. This used to be seen as insensitive, but my university students now tell me they prefer it – again, because a text is read in private. Your reaction to being dumped will not be witnessed by the dumper: it allows you to retain your dignity, and gives you time to craft your reply.

Students also tell me that they rarely speak on the phone to anyone other than their parents without prearranging it. They see unsolicited voice calls as an imposition; text-based communication is preferable (even if it’s less efficient) because it doesn’t demand the recipient’s immediate and undivided attention. Their guiding principle seems to be: “I communicate with whom I want, when I want, and I respect others’ right to do the same.”

I’ll confess to finding this new etiquette off-putting: it seems ungenerous, unspontaneous and self-centred. But I can also see how it might help people cope with the overwhelming and intrusive demands of a world where you’re “always on”. (In her book Always On: Language in an Online and Mobile World, Naomi Baron calls it “volume control”, a way of turning down the incessant noise.) As with the other new practices I’ve mentioned, it’s a strategic adaptation, exploiting the inbuilt capabilities of technology, but in ways that owe more to our own desires and needs than to the conscious intentions of its designers. Or, to put it another way (and forgive me if I adapt a National Rifle Association slogan): technologies don’t change language, people do.

Deborah Cameron is Professor of Language and Communication at the University of Oxford and a fellow of Worcester College

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times