HIV/Aids has severely impacted countless populations, limiting their ability to lead healthy, productive lives and hindered the growth of economies since the identification of its first case in 1980s. Since then, proven prevention options have slowed HIV’s spread but thousands of people continue to get infected daily.
The year 2013 started on a positive note with the news that a child appeared to have been functionally cured of HIV infection in Mississippi, US, after receiving aggressive treatment just 30 hours after birth, reducing the level of the virus in the blood to an undetectable level, although some virus probably remains in the body. Exactly why this happened remains unclear, and the treatment would not work in adults where the virus is already established. But the course of treatment suggested that if treated early enough, the virus could be prevented from establishing what the scientists call a reservoir which once established, makes it difficult to eliminate the virus. This was preceded by a study of 14 French patients who, after being given a standard combination of anti-retroviral therapy within 10 weeks of getting the infection, went off medication and have remained healthy — although still infected with HIV — years after stopping the medication. An encouraging piece of news from our own country has been reported by a team of Indian doctors in the first known cases of nine children who are infected with HIV but able to keep the infection naturally under control; followed by the most recent study by Danish researchers identifying substances which can make the virus more vulnerable to attack. However, despite this progress, 1.7 million people are still being killed by Aids each year, and a safe and effective Aids vaccine is badly needed.
The mysteries of science often take us through blind turns and all the excitement was questioned with the announcement of stopping of a well-conducted clinical trial of a potential Aids vaccine, HVTN 505 by the US National Institute of Allergy and Infectious Diseases last month. The result of the trial did not yield the desired outcome, restating the great challenge that the HIV virus poses for our generation compared to many other viruses. Experts are, however, positive that this study will help provide greater technical learning and has the potential of informing future scientific research.
These differing reports bring to light the astonishing ability of humans to juxtapose the measure of success and failure around such indications, sometimes reassuring and at others disappointing evidence of scientific achievements. What remains conclusive in the case of HIV is that this virus transmutes and replicates at a rate many times faster than any virus ever discovered and studied by science. The HVTN 505 study is additional proof as to why it took the best scientific minds of our century; over 30 years to find cures for viruses like polio and influenza and also the reason why the scientific fraternity’s perseverance at fighting a complex organism like HIV should be viewed with optimism and trust.
More than 30 ongoing Aids vaccine trials worldwide by scientists and researchers, supported by governmental and non-governmental institutions are working through innovative technologies to fulfil the urgent need for a long-term solution to the dreaded disease. Many of these approaches hold valuable clues to the design of more effective HIV vaccine candidates. But to harness them, we must find ways to bypass the market failure that discourages industry involvement.
India, with the third largest number of people infected with HIV, has been remarkably successful in reducing its general incidence of HIV, cutting the annual number of new infections by nearly 50%.
World Aids Vaccine Day has come and gone but we must appreciate the work of various government departments like the National Aids Control Organisation (NACO), Department of Biotechnology (DBT) and Indian Council of Medical Research (ICMR) which, in collaboration with many international agencies, have integrated programmes for prevention, care, support and treatment.
India must take a leading role in the development of an Aids vaccine, building on its established leadership in vaccine manufacturing and strengths in vaccine research and development. Our dream of a world without Aids is still on track and we need to keep doing all we can to reach a dawn that will mark a new chapter in the medical books of ‘successfully conquered and cured’.
Oscar Fernandes is an MP and chairman of the Forum of Parliamentarians on HIV/Aids
The views expressed by the author are personal