Oct 24, 2008

HIV Discoverer Advocates More Science for AIDS Eradication

by Laura Starita

Luc Montagnier, discoverer with Françoise Barré-Sinoussi of the virus that causes AIDS, and joint winner of the 2008 Nobel Prize in Physiology and Medicine, had an opinion piece in the Wall Street Journal this week outlining “The Next Steps to Take in Beating AIDS”. The crux of his recommendation, communicated in somewhat Pynchonesque language, is for pharmaceutical science to explore ways to use AIDS vaccines therapeutically. The idea would be to apply anti-retrovirals (ARVs) to reduce the amount of virus in the blood of HIV-infected people, and then administer vaccines to seek out the hidden pockets of infection and eradicate them, thus returning the body to fully “competent” immune status. Montagnier contends that improved treatment regimes along those lines will reduce the stigma of disease, encourage HIV-status testing and ultimately lead to falling disease rates.

It strikes me as odd that in a world where medical science cannot even say unambiguously whether eating soy is good for you or not there should be such high hope placed in experimental science to provide the solution to the AIDS pandemic. In an effort to tip the balance it might serve to point out a few things that are known within the HIV/AIDS sector. Namely, around 33 million people are infected with the AIDS virus worldwide, and as of 2007 around 2.7 million new infections occur annually, according to the WHO. Of those 33 million infected people, around 3 million are currently on ARV therapy of the estimated 10 million who need them, despite many years of concerted effort and significant funds applied to getting medicines to regions with the greatest disease burden. The efforts of PEPFAR and the Global Fund should be applauded in this regard, but even the most optimistic concede that continued complacency toward the rash of new infections that occur every year will cause the worldwide disease burden to far outweigh the treatment scope for the foreseeable future.

Perhaps most relevant, however, is that Montagnier’s belief that improved treatment will lead to declines in infection is simply false. Another thing we know about HIV is that the countries with the most infected people on treatment see increases in infection rates and high-risk behavior once the treatment programs become more widely available.

I have asked before in these pages why the most esteemed thinkers in HIV/AIDS are so consistently focused on treatment over prevention, and have attempted an answer here. At its most basic level, the problem seems to be prudishness. If we stick to the science of treatment we can comfortably talk about viral structures and cellular loads and immune “competence” and all kinds of things that remove the disease from the human beings who suffer from it. But if we talk about prevention, we will have to talk about sex—when people have it with whom and how often. And we will have to suggest that people do things differently. That’s hard work and will require a great deal of sensitivity and creativity and, yes, money. But some focused effort on that side of the fence might begin to do much of the work well before Dr. Montagnier’s therapeutic vaccines make their way out of the lab.