‘Long Way To Go’ in Fighting HIV/AIDS, Nobel Laureate Says in Opinion Piece
Despite the progress made in the fight against HIV since it was discovered in 1983, there is "still a long way to go," Luc Montagnier, who recently shared the 2008 Nobel Prize in medicine for his work in the discovery of HIV, writes in a Wall Street Journal opinion piece. HIV/AIDS is "spreading in many countries," and even "developed countries like the U.S. have many new infections," he writes, adding, "There is also the danger of a new epidemic caused by viral strains resistant to treatment. Moreover, despite the effort of thousands of researchers, we still have no cure and no vaccine."
According to Montagnier, "many potential preventive vaccines have been experimented with" since 1985. "A few of them made it up to efficacy trials but then failed," he writes, adding that this is "no surprise" to him for "two main, related reasons." The first is that HIV has "evolved to present its most variable parts to the immune system, and it hides its crucial parts in internal pockets," he writes, adding, "Second, the variability potential of the HIV genetic material is enormous, although its origin is not fully understood."
This "complexity means it is very difficult to elicit an immune response that would protect against the many different HIV variants that infect the human population," according to Montagnier. He adds, "In addition to its very high level of variability, HIV has evolved several other strategies to evade the response of the immune system, making it difficult to design an effective vaccine." However, he writes that researchers "know that protection against HIV is possible in natural conditions" -- including in some people who are exposed to HIV but do not contract the virus, as well as in "some rare individuals" who contract HIV "but do not progress toward immunodeficiency and AIDS." He adds, "It is possible that the mechanisms that provide resistance to infection, and those that provide resistance to disease progression, are the same. If this is the case, vaccines capable of eliciting protective immunity could be first tested in HIV-infected individuals for the capacity to delay progression to disease and reduce viral replication."
According to Montagnier, more than 10 years ago he "proposed using vaccination against HIV antigens not for prophylaxis but as an additional therapy following a short antiviral treatment." The goal in this circumstance is to make HIV-positive people's immune systems "fully competent, after only partial restoration by an antiretroviral treatment reducing the viral load in the blood to undetectable levels," he writes.
According to Montagnier, in "developing countries, many infected patients refuse to be tested and are not treated because of the stigma attached to AIDS." He writes that the "availability of treatment able to eradicate the infection will change their attitudes," concluding that the "epidemic will thus gradually decrease, perhaps helped by a preventive vaccine derived from a successful therapeutic vaccine" (Montagnier, Wall Street Journal, 10/21).