“People think the problem of HIV AIDS is over, but it is quite possible that the problem is going to get worse,” said Dr Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative (IAVI), pointing out that the rate of young people acquiring the infection is than higher than before.
With governments across countries less keen to spend on HIV and cases of resistance to HIV drugs rising, Feinberg in an exclusive interview to News18, said, “Historically, the only way a disease has been eradicated is by a vaccine. The innovation that is going to put an end to AIDS is a vaccine.”
After initial attempts to create a vaccine for the disease failed in the late 1980s, IAVI, a global non-profit organisation, was set up in the next decade to accelerate the search for an HIV vaccine. It wasn’t until 2009 that global researchers were able to conduct the first HIV vaccine trial that led to a reduction in the rate of infection by 31.2%, as per World Health Organisation.
Three years later, the Indian government’s Department of Biotechnology’s Translational Health Science and Technology Institute (THSTI) set up the HIV Vaccine Translational Research Laboratory jointly with the IAVI. Doctors there told News18 that the research has been very fruitful and they remained hopeful.
That hope, Feinberg admitted, was the key. Feinberg leads the global team working to advance the development of vaccines and other biomedical innovations to protect against HIV.
“It is really worrisome that the fate of millions of people is susceptible to changing political will. If you think of the total bill people will pay for AIDS before it is over, it is going to be enormous,” he said.
But Why a Vaccine?
The problem with the HIV AIDS virus is how rapidly it goes past immune defenses and how rapidly it figures out how to defend itself through quick mutations, said doctors at THSTI.
As per the WHO, the HIV mutates rapidly and its outer spike of protein conceals itself from the immune system. Creating viral antigens to combat this has proven difficult– that is until 2009. The research found out that a small number of HIV infected people, roughly one in five, produced a “broadly neutralising antibody” (bNAbs) which kept the viruses suppressed and asymptomatic for decades. If bNAbs could be elicited quickly through vaccination, it could effectively prevent HIV infections, the researchers hope.
“The AIDS vaccine is going to be crucial to end the epidemic,” said Feinberg, adding, “Treatment is a necessary solution. But a complicated one, it requires rigorous adherence, failing which there will be complications.”
In National Aids Control Organisation’s report of 2017, five states in India bucked the national trend with cases of new HIV infections increasing as compared to 2010.
It added, “There is no room for complacency”, while noting that although HIV infections had declined by more than 60% since 2000, the rate of their decline has been much slower in recent years and far behind the pace needed to reach the 2020 target.
Moreover, while roughly half of those infected are under treatment, the rest aren’t. Feinberg said, “Those that are easiest to reach have now been reached.” Those who don’t know they’re infected, those not well connected to health care, stigamatised or marginalized groups remain to be brought under treatment.
Why Has HIV Faded into Background?
A Lancet study published last month pointed out that between 2012 and 2016, the development assistance for HIV / AIDS dropped by 20%, thus making domestic financing “critical to sustaining the response to HIV/AIDS” and found that a “large gap exists between available financing and the funding needed to achieve global HIV/AID goals.”
Feinberg reasoned, “I think the longer something is around, the more it fades into the background.” He added, “When the HIV first arrived it was viewed as a death sentence. The consequences were visible and many people across countries very dying terribly.” He further said that it was a new problem and no one, had until then, seen anything like it.
“We thought we knew all the diseases and we could tackle them one by one. But this was a new disease arriving out of the blue. We have a better understanding of it now,” he said.
“It is basic human nature, when a problem is new, people pay attention to it. When it has been around for a long time, it goes to the back of the mind,” he added.
Threat of HIV Drug Resistance
The standard Antiretroviral Therapy (ART) consists of the combination of three Antiretroviral (ARV) drugs to suppress the HIV virus and stop the progression of the disease. With no cure, the therapy helps suppress the disease by pushing the virus into a latent form.
But the HIV drug resistance (HIVDR), the ability of the HIV virus to mutate and reproduce itself in the presence of these drugs, can lead to treatment failure and further spread of the drug resistant HIV. The WHO, which is developing a five-year global action plan for 2017-21 to support coordinated efforts against HIVDR, added that this can compromise the effectiveness of the limited therapeutic options to reach the last 90 target (of achieving viral suppression) and further reduce HIV incidence, mortality and morbidity.
“Even people who don’t have HIV, when they get a prescription from a doctor, they rarely take it exactly as recommended and that is just for a week. In the case of HIV, you’ve do it rigorously for life and if you don’t, the virus will become resistant to the drug,” added Feinberg.
A further issue, he explained was that while India was the capital for generic, cheap ARV drugs that were saving lives across the world, drugs for drug resistant HIV are made by innovator pharmaceutical companies in the US and Europe. “Unlike the Indian model, which is large volume and cheap prices, they charge more, since that is their business model. The number of drug resistant cases are less, so they’re more expensive,” he said, adding that as a result those drugs don’t have a “direct pathway” to reach low income companies.
“This isn’t just a problem for patients or physicians. But also the entire healthcare system, which comes under pressure as a result,” he added.