Dr Robert C Gallo is best known as the co-discoverer of HIV as the cause of AIDS. He is also the Co-Founder & Director, Institute of Human Virology at the University of Maryland School of Medicine and Co-Founder & Scientific Director, Global Virus Network. He shares his insights about AIDS, research on the disease, challenges associated in managing it effectively and more, in an interaction with Lakshmipriya Nair
What have been the major breakthroughs in AIDS research in the 30 years since you co-discovered HIV as the cause of AIDS?
The major breakthroughs are as follows:
- Our development of the HIV blood test in 1984 and the application of that blood test by some of the big companies to make a global test possible.
- Of course, additionally the development of drug therapy beginning in 1986 with AZT, make these the two great practical advances in the field.
- The demonstration by ‘Slim’ Karim of South Africa that microbicides could block HIV infection when used properly by women. While this may not be so readily applicable, when properly done drugs can be long-lasting and act to prevent infection in the female genital track.
- The detailed understanding of how HIV enters cells and approaches now of how to take advantage of this knowledge for the development of a vaccine, though this is still in progress. We don’t yet have an effective vaccine.
- The US President’s Emergency Plan For AIDS Relief (PEPFAR) programme initiated by former US President, George W Bush to bring therapy to needy nations in Africa and the Caribbean.
Can genes play a role in increasing susceptibility towards AIDS?
Yes, and resistance as well.
How close are we towards finding a cure for AIDS? Is it possible to eliminate it completely?
It is not possible to eliminate it completely. The prospects are remote. But since we can manage the virus with therapy, it is already a well-treated disease. So, when you know you are infected, and when you have access to properly trained physicians and you adhere to the regiments it is a well-treated disease. When people talk about cure today, people are generally talking about what we call a functional cure. This means you may not need the drugs any longer that the virus is so low in amount that the remaining immune system can keep it in check forever more – this is a possibility but I cannot tell you when that will be forthcoming. One suspects that within five years a functional cure might be achieved.
Tell us about your recent research in this sphere?
There is not much to say about our research into the cure. It is complicated and not yet at a practical level. Indeed, we are spending more time on trying to develop an effective preventive vaccine sponsored mainly by the Bill & Melinda Gates Foundation in Seattle, Washington, US and in part by the National Institutes of Health in Bethesda, Maryland, US. We are beginning phase 1 clinical trials for the preventive vaccine next year.
India has a huge AIDS burden (third largest in the world). What should be some of our immediate measures to intensify the fight against AIDS?
To be certain that there is nationwide adequate testing and to reach out to clinics, hospitals, doctors, to be sure there is adequate testing of people. The blood test is essential to find out who is infected. Even in the US, where we have long experience and a lot of testing being done, it is estimated that 20 per cent of infected Americans don’t even know they are infected. So, the most important thing is reaching out and testing people as much as possible, and once known to be positive to be sure they are on therapy immediately with proper follow up by doctors well-trained in HIV therapy.
What should be the focus areas globally to control the AIDS pandemic? Where are we lagging behind?
Money. We need much more finances to make sure people who are infected are treated. Trying to reach as close to 100 per cent as possible. Again this requires reaching out and testing, and adequate testing for therapy. As I mentioned before, the US PEPFAR programme has been involved in greatly increasing the number of people treated in Africa but we need much more of that and we need more nations participating as the US has done, and to help people in need. The US needs to continue this and, if possible, to increase it.