A significant discovery, now a dream for a cure
Françoise Barré-Sinoussi spoke to the Bulletin about her work on HIV research and of her hopes for progress in knowledge and treatment.
Q: What was the sequence of events that led to the discovery of HIV back in the early 1980s? What was the atmosphere in your team when you realized that you had identified a new virus?
A: The discovery wasn't made at a specific moment but was a progressive process involving close work with our clinician colleagues, from the bedside [of patients] to the bench and back to the bedside. In June 1981, reports started emerging in the United States of America of cases of pneumocystis pneumonia among previously healthy men in Los Angeles, and later in other cities. In January 1983, Willy Rozenbaum, a clinician who knew that we were working on retroviruses, approached us with a patient who had gone into a stage of immunodeficiency and who had agreed to accept a lymph node biopsy.
We thought that it could be a type of HTLV (human T-lymphotropic virus, the first human retrovirus, which was identified in 1977), so we had to grow the virus in culture and see if it had any relationship with HTLV. We checked the culture every three to four days and managed to keep the virus-infected cells alive for three weeks by adding lymphocytes from donors. This strategy turned out to be a good one. If we had left the culture for months, all the cells would have died. In May 1983, we were able to report in Science that we had isolated a new virus that was probably causing the disease known as AIDS. This was proven a few months later. I remember telephoning a friend in the US to say that I thought we had a new discovery. He joked that I should throw it all in the trash because of what we would unleash.
Q: According to UNAIDS, in 2007 there were 33 million people living with HIV, 2.7 million people newly infected with the virus and 2 million deaths worldwide. What challenges remain in the fight against HIV/AIDS 25 years after your discovery?
A: There has been a lot of progress towards providing access to treatment but we still have a lot to do in this area. It is a United Nations goal that, by 2010, everyone living with HIV should have access to antiretroviral treatment. Today only 30% of those in need have access to it in low- and middle-income countries. While universal access will be extremely hard to achieve, we need to advocate for this goal so that governments continue to work towards it. Caring for people with HIV is a lifelong commitment that involves dealing with chronic disease, drug resistance and, of course, prevention. We have had partial success in preventing transmission, particularly from mother to child, but so many women still don't have access to these programmes. Work is in progress on vaccine development, microbicides and pre- and post-exposure prophylaxis. While there are economic limits, the dream is to find a cure for HIV infection.
Q: Why is it so difficult to develop a vaccine for HIV?
A: The genetic variability of HIV is one obstacle, another is the way the virus stores itself in 'reservoirs' such as the lymph nodes of the intestinal region. Eradication will not be easy because the virus stays in these 'reservoirs' and is not affected by the immune response, even after 10 years of antiretroviral treatment. When treatment is interrupted, the virus is reactivated and patients experience a recurrence of the disease. There is evidence today that the immune response to HIV occurs much earlier than previously thought. It is possible that everything is determined in the hours following infection. Early diagnosis and treatment are very important; maybe we are treating people too late now. If we can better understand the way the infection evolves in the host, then we can work on developing therapeutic vaccines. A vaccine should aim to block cell-to-cell transmission, but we don't know how to do this yet. If we can make progress in developing vaccine strategies for HIV, then I'm convinced that we will make progress in developing vaccines for other diseases too.
Q: People working on other health problems sometimes feel that a disproportionate amount of money is allocated to HIV/AIDS.
A: I'm very surprised to see conflict between people working, for example, on avian flu or malaria research, saying that too much money is devoted to HIV and not enough to other diseases. It is mistake and a misconception to oppose the fight against HIV in favour of other health issues. Working together is the best response to global health issues in general. I've seen the impact that HIV care, prevention and treatment programmes have on strengthening health systems. I wonder whether we could have avoided the current situation of multidrug resistance in tuberculosis patients if the communities working on HIV and tuberculosis had been working more closely together from the beginning. My message to the global health community is that we must continue the efforts that we started, with a strong commitment from governments in industrialized countries. The transmission of this virus is easily prevented and the promotion of practices such as condom use are key. We also need to promote testing to enable early diagnosis and treatment.
Q: Can you name an example where this is already happening?
A: In Cambodia there has been an improvement overall in the health system as a result of specific work on HIV. In 1995, the country didn't really have a functioning health system. By 2008, it had 50 sites for patients with opportunistic infections and antiretroviral treatment, 26 sites for paediatric HIV care and 4 sites for monitoring CD4+ counts. With the support of the Global Fund to fight AIDS, Tuberculosis and Malaria, 30 000 patients are now enrolled in HAART (highly active antiretroviral therapy) programmes. We expect that everyone who needs treatment there will be covered by 2010. The effect is not only improving the health of people with HIV but of those with other diseases such as tuberculosis.
Q: What projections do you have for a child born with HIV today?
A: As a researcher, I lack the ability to be completely optimistic. But if we can treat people early, then we can bring them hope. Prolonging life might provide time to develop new strategies for the future. I'm not sure that we will succeed in eradicating the disease but I am convinced that we'll be able to treat all HIV carriers so that they no longer have detectable levels of the virus and cannot transmit it to others.
Q: How has winning the Nobel Prize affected you?
A: I feel an enormous responsibility. I hope that I will be able to convey a strong message to the authorities, to political organizations and to youth that it's time to provide incentives to young researchers to work on HIV. We strongly need new spirit if we want to develop creative, novel strategies for a vaccine. We need to encourage scientists from other areas, such as immunology, even nanotechnology. Myself, I want to go back to the lab! At one point in my life, I wondered whether I had made the right choice to concentrate on this particular virus. But, for me, it's sufficient to go to Africa or south-east Asia and interact with people living with HIV. The motivation comes when I feel that I can really help the people affected.