During my six years as an immunology grad student, HIV research papers that had the words ‘T cells,’ ‘antibodies’ and ‘vaccine’ in them always sat on or near the top of my must-read pile. I read those papers with enthusiasm even though, by the time I got to figure 4 or 5 in the ‘results’ section, their gist seemed to carry a whiff of discouragement. When I graduated, my ardor cooled a bit. The jobs that I stumbled into required my antennae to be retuned to catch news from all fields of biomedical research. But I still kept au courant with the topic via review papers and news summaries, if not primary articles.
Then I started to read about HIV researchers saying that maybe it wasn’t realistic to hope for a sterilizing cure – the kind you get when the virus is completely wiped out in each and every infected cell of a person. Researchers had figured out how to treat HIV patients with combinations of anti-HIV drugs so that viral loads were kept low and CD4 T cell counts relatively high. Patients who maintain a certain ratio of CD4 T cells (the immune cells that the virus attacks and kills off) to viral load have been able to live symptom-free longer and with relatively small toxicity-induced organ damage. So maybe, these researchers said, the anti-HIV drug combos, which were getting cheaper and cheaper, were as good as it was ever going to get.
And then in 2007, Merck’s experimental HIV vaccine, which was then the research community’s big hope, flopped in a hugely disappointing trial. After that, I really couldn’t dredge up the enthusiasm to follow the field.
This summer, though, HIV/AIDS news seems to have inexplicably become impossible to ignore. A bunch of “Can-we-cure-AIDS?” type of stories have started to appear in many major science and popular news outlets. (Or maybe this sudden reappearance is not so inexplicable. The 18th International AIDS Conference starts in Vienna today and maybe some scientist somewhere has good news that was selectively leaked and that will soon be known to all. One can hope.)
The good: In the meantime, Nature magazine has produced a special news section that rounds up all the positive research news produced in the last couple of years. Jon Cohen’s piece in MIT’s Tech Review, which preceeded Nature’s coverage, is also an upbeat read and covers many of the same discoveries and advances.
The good news is that scientists seem to now have a broader and clearer understanding of HIV’s complicated lifestyle. They’ve figured out where it hides out within the body and how it tricks the immune system into exhausting itself. One research team found a way to completely get rid of a German man’s HIV load via a bone marrow transplant and allow him to survive HIV-free even without drugs. Some reseachers have figured out how to reverse-engineer an antibody that can neutralize the virus and others are close to building a vaccine that can prevent infection in the first place.
The bad: But scientists have also learned that good news for some might be bad news for others. Another vaccine, this one tested in Thailand, was only feebly successful – it failed to work for most of those who got it. Scientists have uncovered clues that suggest that a one-size-fits-all/foolproof anti-HIV strategy might be impossible. Each person’s immune system seems to handle HIV differently. And each of the dozens of HIV strains that are circulating out there offers its own set of challenges and hurdles that drugs or therapies designed against one or two strains might fail to overcome.
The sad: But exulting over the ups and obsessing over the downs of HIV research seem almost pointless in the shadow of the situation in, say, Uganda, where they’re having to turn away patients because the money for drugs has run out. Back in May, Donald McNeil wrote an utterly stunning series of articles in the NYTimes that laid out the problem in the starkest of terms.
For all the billions spent in setting up well-supplied clinics and public health education and training programs, current prevention practices have not only failed, but yielded this shocking statistic: for every two people treated, McNeil reports, five more are infected.
After being lulled into a ‘we’re-all-in-this-together’ comfort zone by stories of heroic levels of AIDS-and-Africa-related fundraising by the 3 Bs (Bill Clinton and Bill Gates and Bono) and others, McNeil’s articles were like a bomb going off in my head. In the carnage left behind by the explosion, hope became a casualty and optimism got swept away by despair.
The global recession is partly to blame for the money shortage, but so is a misguided new policy that has big donors like the US government and the Gates Foundation redirecting money from AIDS efforts to treatment of early childhood diseases like measles and diarrhea, and maternal care. This is one battle that I wish AIDS activists and lobbyists hadn’t lost. Of course, programs like child-and-mother health programs are important, but I mean, what’s the point in saving a newborn or infant only to have him/her die of AIDS later on?
High infection rates and crappy prevention and treatment policies are no longer an issue just in Africa, but also in Eastern Europe and Russia, reports the journal Science in its AIDS package. While these series of articles don’t pack the same emotional punch as the NYTimes’ pieces, they’re a tour de force of reporting about the various facets—policy, politics, funding, research, and socioeconomics—of an emerging AIDS crisis.
With all this coverage, of good news and bad, one thing’s definitely changed for me: I’m going start paying attention to HIV again.