As promised in my previous post, here’s more from Dr. Anthony Fauci, a leading expert on HIV/AIDS and director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. I asked him for a summary of new findings and advances in preventing the spread of HIV/AIDS and finding a cure for those infected.
Since my interview with Dr. Fauci, another new finding was announced. As reported by the Globe, an international team of researchers has cracked the genetic code of the “controllers,” a mystifying group of individuals infected with HIV who are virtually free of symptoms and the need for medication. The researchers discovered five amino acids that distinguish controllers from their HIV counterparts facing less fortunate fates.
An excerpt from the Globe:
“HIV is slowly revealing its secrets,’’ said Dr. Bruce Walker, one of the leaders of the international consortium and director of the Ragon Institute, an AIDS-vaccine research center affiliated with Massachusetts General Hospital, Harvard University, and MIT.
“We’ve now been able to go from a haystack down to a needle and see that this is really the key place where we need to focus our effort,’’ he said.
Have there been any breakthroughs or developments in HIV/AIDS research?
Dr. Anthony Fauci: The first is in the arena of vaccine. We have been trying for over 20 years to develop a safe and effective vaccine, with nothing but unfortunate and discouraging failures. But a year and a half ago, in a trial that the NIH and the Department of Defense sponsored in Thailand among 16,000 people, it was the first indication of a modest, positive effect of preventing acquisition of HIV infection. It is not good enough to be ready for primetime by any means, but it’s the first positive step to prove the concept that a vaccine is at least feasible.
Also, this past year we’ve had some very encouraging results of studies that were conducted in South Africa using a topical microbicide — a vaginal gel which is inserted before and after intercourse — that prevented infection in, again, a modest number of individuals, about 39 percent compared to placebo. It was strongly related to whether or not the individuals actually used the gel. But this is again another important proof of concept. We have to improve upon the results, but at least it’s proved that this approach to prevention can work. So in the areas of microbicides and vaccine, [it’s] not quite yet where we want to be, but certainly going in the right direction.
Another important area that is being pursued is what’s called pre-exposure prophylaxis: mainly getting people who are at high risk and practicing high risk behavior – for example, discordant couples, commercial sex workers, injection drug users and others — and giving them a drug, every day, an anti-viral drug that is known to be safe, to prevent them from getting infected. The results of that study should be forthcoming in the next month or so.
What are the timelines for the development of such prevention methods and vaccines?
If you’re talking about vaccines, it is unlikely that a really safe and effective vaccine is going to be available for the next several years, if in fact we get them.
Microbicides on the other hand, are a different story, particularly in the developing world. It is likely that within a year or so, microbicides — and hopefully as the years go by they’ll get better and better — but one that is at least reasonable, will likely be available in the next couple of years.
When you talk about something like pre-exposure prophylaxis, I think that’s something — since we already have the drugs approved — that if the trials show that that in fact works, I think that would be available much sooner.
Where will these anti-HIV treatments be implemented first, the U.S. or other parts of the world?
In order for something to get approved by the FDA, you have to have at least two good studies showing that the product in question is both safe and effective. The need for a topical microbicide in the developed world, although it does exist, is not as compelling as in the developing world, where women, in many cases disenfranchised, don’t have many basic human rights to decide whether or not they are or they aren’t going to have a sexual encounter.
Sometimes [women in the developing world] cannot negotiate the use of a condom with their male partner—they’ll wind up getting abused if they try that. In some subcultures in the United States this is true, but for the most part, there are a number of options for women [in the U.S.] to avoid HIV infection that are not available to the developing world.
So that would mean that the health officials in the developing world would likely approve the use of a topical microbicide as soon as they see that there’s enough data to indicate that it’s worthwhile. Whereas in the United States, it probably would require a couple of studies to absolutely prove the safety and efficacy of it, because the need for it is so much more compelling in the developing world.
Do you think it’s possible to discover a cure for anyone and everyone infected with HIV?
I think it’s attainable in some individuals, and I think you’d have to get them very early in the course of their infection. Once their immune system is so terribly damaged that when you stop therapy there’s not enough immunity left to contain the residual virus, then I don’t think it’s going to be possible.
So to be realistic, I don’t think it’s possible to even imagine a cure in everybody who’s HIV infected. But in some select individuals who get treated early in the course of infection, I do believe that this is feasible.
Note: This interview was edited for brevity and clarity.