She Helped Discover HIV 30 Years Ago - Now, It's Time To Defeat Research "Dogma"
On the 30th anniversary of her landmark discovery, French Nobel Laureate Françoise Barré-Sinoussi calls for a new approach for definitively defeating AIDS.
PARIS - Thirty years ago, on May 28, 1983, French virologist Françoise Barré-Sinoussi was the first to describe how researchers had identified the human immunodeficiency virus (HIV) responsible for AIDS, in an article published in the prestigious American journal Science
Awarded the Nobel Prize for Medicine in 2008 along with Luc Montagnier, Barré-Sinoussi still works at the Pasteur Institute – a French foundation for research and public health. Ahead of an international symposium commemorating 30 years of research on HIV, she talks to Le Monde about what’s next in the fight against a pandemic that has cost the lives of 28 million people since 1981.
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Nobel Prize Laureate Françoise Barré-Sinoussi - Photo: Prolineserver - GNU
LE MONDE: From the beginning of the epidemic, researchers have said that a vaccine could be developed in about ten years. After all the unsuccessful vaccine trials, do you still think this is possible?
FRANCOISE BARRE-SINOUSSI: I still believe we can find a cure for AIDS, but to do so, we need to change the way we think, change the dogma of research in this particular field. We need to find new approaches, because so far, all the empirical attempts at developing a vaccine, and a vector to carry it, have failed.
The international STEP trial – which started in 2004 with 3,000 volunteers from America and Australia and a candidate vaccine from the Merck laboratory – ended in 2007, after it was determined that it was unsuccessful at protecting against the virus. Until then, the concept was: “Let’s try and we’ll see what happens,” because that is the way many of today’s efficient vaccines were found. The problem is, this does not work for HIV. When positive results were obtained – like for instance with the 2003 “Thai” trial carried on 16,000 men and women in Thailand – the results remained modest.
What could these new approaches be?
They will result from a return to fundamental research, but as I said before, this can work only if researchers free themselves from dogmas. The usual vaccines protect us by inducting antibodies, which prevent the virus from entering the cells. None of the HIV vaccines have managed to produce that type of antibodies.
However, we have gained further knowledge on another type of antibodies. We need to understand what the best response is in order to protect patients. This is true for HIV as well as for other diseases which have no vaccine yet: malaria, hepatitis C, tuberculosis…
I like the idea of identifying on vaccines that work – like the one for yellow fever – the first signs of immune response, so that we can compare them to unsuccessful HIV vaccines.
We must also learn from the studies that have revealed a sub-category of particular antibodies, which were found on people living with VIH and for who the infection seems to have been blocked. We are still in the very early stages of research on this.
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Scanning electron micrograph of HIV-1 budding (in green) - Photo: C. Goldsmith
When do you think this work could bring successful results?
I would not like to hazard a guess on the exact date.
What have you learnt from these 30 years of research?
We have witnessed a great example of what is called translational research – all the sectors of medical research have come together to find the best solutions of diagnosis, treatment and prevention for people suffering from HIV. This was the prevailing spirit from the start.
We had to go through a very hard period of time during which infected people where dropping like flies. Lab researchers like me were not used to being in contact with patients. But here, relationships and stories were formed. It made us re-evaluate our work. The everyday relationship with patients and civil society representatives had a real impact on research programs priorities. Today, I could not imagine my job without this contact with patients.
The International Aids Society (IAS) – of which you are president – and scientists working on HIV in general had a very militant position from the start…â€¨â€¨
Scientist do everything they can, as fast as possible, so that the prevention, diagnosis and treatment tools can be accessible everywhere. So when this is not the case, it becomes unbearable. It makes us angry, and this anger does not subside with time… But with the help of militants, I think we were able to raise awareness much better.
In 2012, The IAS launched a campaign called Towards an HIV Cure. What are its objectives?
Our objective is to accelerate cross-disciplinary research. We wish to integrate basic research with clinical research, social sciences. Contrary to other initiatives, this one was not instigated by silent partners or international agencies, but by scientists. Our goal is to get funds for specific projects.
One of our biggest problems right now is getting physical access to HIV-positive people so that we can offer them the existing solutions that can give them a quasi-normal life expectancy. This will cost a lot of money, but there is no doubt that it is the best way forward.
Moreover, in many countries, the fight against HIV is a way of raising the general quality of health systems by developing more comprehensive health programs. Such a strategy means exponential costs – because it means a longer life expectancy for patients – but it is eventually profitable.
Over the years, there have been different points of views on what the best treatment was for people living with HIV. What is the accepted theory today?
There is an ongoing debate about what is the best time to start the antiviral treatment. Now we know that the HIV virus infiltrates different areas of the organism at a very early stage, and remains latent in these hidden areas… until the moment it is reactivated. This is the reason why treatment needs to be stronger, and start earlier than it did in the past.
There are also difficulties arising from the fact that for now, the treatment remains a life-long one. In France, a group of patients know as the “Visconti cohort” started a three-year treatment within ten weeks of being infected. For most of them, the infection is still under control, sometimes seven years after the end of the treatment. This is an encouraging result.