It’s World AIDS Day, and here we are: AIDS is no longer an automatic death sentence for everyone who tests positive for HIV. So, why should we reflect back on the last most terrifying deadly pandemic of recent times?
Well, partly because AIDS is still with us, and still carries a death sentence for many, depending on where they live in the world, what cultural mores and baggage they happen to bear, and whether they can afford the not-exactly-cheap cost of the drugs needed to keep HIV at bay. That’s one thing.
Another thing — and this is important, and underreported — is the fact that AIDS research dating back to the 1980s and -90s is the backbone on which the COVID research of today is built.
Yes, that’s right: SARS-CoV2 research today hinges on the HIV research of yesteryear. How?
Well, for starters: Viral genome sequencing, which used to take weeks or even months back in the 1980s, now takes far less time. But it’s the same basic procedure, and it’s helping unravel viruses of all kinds faster, so scientists can develop vaccines against them.
And, moreover: The effort to find a vaccine against HIV has actually driven the mRNA vaccine research that has given us the Pfizer and Moderna vaccines against COVID.
The Covid vaccines were sequenced, developed and approved in the U.S. in record time, but that would not have been possible without decades of work by HIV researchers.
“Almost everybody working on Covid vaccines comes from the HIV world,” said Mitchell Warren, executive director of AVAC, a global advocacy group for HIV prevention. “Moderna had been working on mRNA-based HIV vaccine before SARS-CoV-2 was even known to exist.”
An HIV vaccine has eluded scientists for decades. The traditional thinking around vaccines is to mimic the body’s natural immune response to a virus. The problem with HIV is the body’s natural immune response isn’t strong enough to fight the virus. This means a vaccine has to come at the problem in a different way. Scientists are hopeful that mRNA technology — the same technology used in the Covid vaccines from Moderna and Pfizer-BioNTech — could be a turning point.
This comes as no surprise to those of us who’ve been following AIDS research since the human immunodeficiency virus first hit the media in the early 1980s. The same Dr. Anthony Fauci that the far-right loves to demonize today was, in fact, an AIDS researcher back in the day — it was where his career really took off.
And while it’s been four decades since AIDS research got off the ground, and no vaccine is yet available for HIV, we’re now closer to actually seeing one — in turn, thanks to COVID:
For four decades, the human immunodeficiency virus (HIV) has managed to elude the immune system’s attempts to eliminate it. This is due to several factors, including the virus’s ability to rapidly evolve to produce new mutations that help it evade antibodies. The virus has also found a way to camouflage its outer layer (the HIV envelope glycoprotein, or HIV env) with the same sugar chains found on human proteins, so that it remains hidden from attack. Like the coronavirus, HIV env uses protein spikes to attach to and enter host cells and infect them.
IAVI and Scripps Research may have discovered an important key to crack the virus’s impenetrable armor. They’ve come up with a way to engineer an immunogen (a type of antigen that elicits an immune response) that both looks like the HIV env structure and can induce specific immature B cells to develop broadly neutralizing antibodies before a person is exposed. Importantly, only 10%-20% of people infected with HIV develop broadly neutralizing antibodies on their own, most commonly after several years.
The hypothesis that the mRNA-1644 vaccine candidate can activate certain types of immature B cells to produce targeted broadly neutralizing antibodies was first explored in laboratory and animal studies, and then in human subjects.
In the human study, 48 healthy, HIV-negative adults received two doses of a scientifically engineered, protein-based immunogen or placebo 2 months apart. The findings, which were presented earlier this year at the HIV Research for Prevention annual meeting, provided the “proof of concept” — no safety issues emerged, and 97% of people who got the vaccine candidate produced the desired response: the production of specific immature B cells.
And that’s not all. The antiviral drugs that can hold HIV at bay and prevent full-blown AIDS have even given rise to a new cocktail of drugs to fight COVID:
Pfizer’s pill, scientifically known as PF-07321332, is part of a class of medicines called protease inhibitors and works by inhibiting an enzyme the virus needs to replicate in human cells. Protease inhibitors are used to treat other viral pathogens such as HIV and hepatitis C.
The HIV drug helps slow the metabolism, or breakdown, of Pfizer’s pill in order for it to remain active in the body for longer periods of time at higher concentrations, the company said.
The company said its data on the drug is based on a mid-to-late stage study of 1,219 adults who had at least one underlying medical condition and a laboratory-confirmed infection within a five-day period. Participants were also given a low dose of ritonavir, a medication commonly used in combination treatments for HIV.
Pfizer said there were six hospitalizations and zero deaths out of the 607 trial participants who received the pill in combination with the HIV drug within five days of symptom onset. That compares with 41 hospitalizations and 10 deaths out of the 612 people who received a placebo.
“These data suggest that our oral antiviral candidate, if approved by regulatory authorities, has the potential to save patients’ lives, reduce the severity of COVID-19 infections, and eliminate up to nine out of ten hospitalizations,” Pfizer CEO Albert Bourla said in a statement.
Unlike Gilead Sciences’ intravenous drug remdesivir, Pfizer’s and Merck’s drugs can be taken by mouth. While vaccinations remain the best form of protection against the virus, health experts hope pills like these will keep the disease from progressing in those who do get infected and prevent trips to the hospital.
So, in short, there’s a lot of hope in the battle against two seemingly very different viral diseases. And the day we see a vaccine against HIV could be closer than anyone currently thinks, even if it has been decades in the making.
In the meantime, take care and stay safe. And oh yeah: LISTEN TO DOCTORS.
