Lindau, Germany: More than 25 years ago, when French virologist Francoise Barre-Sinoussi co-discovered HIV, the retrovirus causing AIDS, she thought treatment and cure would be the logical outcomes of their discovery. The virus proved them wrong. However, it did unite the global scientific and public health communities in a way that has become a model of transnational research, taking bench science to the bedside in a short time.
Yet, with attempts of developing AIDS vaccines hitting repeated failures and a section of society, including the World Bank, claiming that HIV/AIDS disproportionately garners attention and funds at the cost of other public health programmes, she stands firm in her conviction that failures haven’t gone in vain and that the scientific community is on the right track.
Barre-Sinoussi has been extensively involved in AIDS control programmes worldwide, including India, where she thinks the bureaucracy is impeding fast progress. On the sidelines of a Nobel laureates’ meeting in Lindau, Barre-Sinoussi, who won the Nobel for medicine in 2008, spoke about why a vaccine looks distant and why HIV can never be eradicated. Edited excerpts:
What were your first thoughts when you identified the virus—that you’d look for a cure or a way to stop its spread?
Both, because we were quite naive. We did not imagine the magnitude of the problem. But in treatment, the development has been fast anyway.
The vaccine work started in 1985, but there’s still no success. Do you think there’s a need to go back to the drawing board and think of some unusual creative approach?
Yes, and a large proportion of the scientific community thinks so, too. After the STEP trial (a trial largely supported by the drug company Merck and Co. Inc. which tested the idea of stimulating the human immune system’s killer T-cells to attack HIV), it was very clear we have to go back to basic science and rebalance basic and clinical research.
Are you implying that somewhere along the way, the focus shifted more towards clinical research and basic science got neglected?
Maybe. Basic research was not considered as top priority while seeking and granting funds. But now we have started the process and have called for fresh applications. There are also fresh calls for studying HIV controllers (a subset of HIV-infected people who are able to control virus replication without any aid). For example, we haven’t paid attention to the monkey model (monkeys in Africa do not develop the disease). All these things were being studied but not with much rigour.
Long battle: Francoise Barre-Sinoussi says India has some very good and dedicated scientists, but bureaucracy is a big hurdle. Gerard Cerles/AFP
As regards the vaccine, I don’t think it’s a complete failure. There’s enough knowledge gained. Moreover, HIV is not alone, we don’t have a vaccine for malaria, Hepatitis-C, herpes virus, and the one against tuberculosis doesn’t work very well. So a piece of the puzzle is missing in vaccine research globally. We need to study even the vaccines that are successful to better understand how they work. In reality, we do not understand the basic mechanism of induction of protective antibodies by a vaccine.
What is the most challenging part in HIV we still do not understand?
We don’t understand what are the very first components of the virus that are capable of inducing abnormal signals for activation of immune cells. We suspect a few, but don’t know precisely what are the first sequences of the proteins that cause the problem. I think if we know that, we should put that epitome in future vaccine programmes.
Do you think that the field needs a fresh infusion of talent? Young researchers are hardly studying HIV these days.
We certainly need new, young researchers, who are naive in this field. The old generation has a broad view but maybe there are key issues which we don’t see because we’ve been in this field for so long. I am pushing for this at various forums. The National Institutes of Health (of the US) is starting a new programme to support young investigators in HIV.
You work all over the world. Do you think developing countries are adequately participating in research as well as in the strategy of fighting AIDS?
I don’t think countries like South Africa or India can be called developing, they are emerging nations. That apart, I think HIV is the only discipline where there is true engagement of countries, they even design their trials and make other proposals. I am not saying it’s perfect, but we are on the right track.
Will we ever eradicate HIV?
I don’t think we can totally eliminate HIV from the body. We can control and transform it. If it is happening naturally (in HIV controllers), then we should be able to do it in infected people as well. But I think if we can control HIV, then we can prevent it. That’s the way to go. Though there isn’t 100% consensus on it, but that’s because of feasibility issues, not due to a lack of scientific evidence.
You’ve travelled to India several times. Do you think the AIDS programme is working fine?
At one point I tried starting a mother-to-child transmission programme in India. We even got money for it, but the local bureaucracy delayed it so much that someone else did it. I think India has some very good and dedicated scientists, but given the state of bureaucracy, I wonder how much they are able to collaborateinternationally, or even nationally.