News From Baltimore: 13th IHV Meeting - Part II -
Professor Robert Gallo interview following the "Annual International Meeting of the Institute of Human Virology", October 30 - November 2, 2011.
Following these intense 4 days of scientific exchanges, Professor Robert Gallo kindly agreed to give us more of his precious time.
Alain Lafeuillade: An entire symposium tackled the issues of HIV prevention and care in Africa. Could you tell us how the IHV is involved in these programs?
Robert Gallo: We are involved in all facets of what your question addresses, namely, our programs in Africa have heavily involved education – especially related to prevention of infection.
Programs in Africa also have to do with blood testing, drug therapy, and treating people who are infected with HIV in the earliest phase possible from their time of infection.
Consequently we have many outreach smaller satellite areas linked to the major centers in a given country.
Finally, as important as anything, is our training, which includes the training of physicians and paramedical helpers for the African crisis. This is done in the field of Africa but also by bringing numerous African physicians and medical scientists to the Institute throughout a given year.
Chronologically, we started with a small amount of seed money from Italy to help train African physicians. I had received such funding when I was at NIH at the National Cancer Institute and distributed it to European medical scientists that had some training programs in Africa. This was followed by a chance entry into my laboratory by Dr. Alash’le Abimiku from Nigeria. I soon realized her value and her interest was more epidemiology and testing, etc so when we moved to form IHV in Baltimore, I moved her to my colleague, Dr. Bill Blattner’s IHV Division of Epidemiology and Prevention. Her role became critical. She did what I think is the best thing for a foreign post-doctoral fellow training in the U.S. She didn’t stay in America like many do nor did she go back completely to her own country, but rather she formed a liaison by going back and forth to Africa, especially her homeland of Nigeria. This substantially advanced our program, and when the Bill & Melinda Gates Foundation got involved in helping Africa, Harvard University received a substantial amount of funding to be involved. They quickly subcontracted to us for Nigeria.
Soon thereafter, the last U.S. President (President George W. Bush) created the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) continued by U.S. President Barack Obama totaling $58 billion over five years. We were recipients of a few major grants of the PEPFAR program. This enabled us to be in seven African and two Caribbean nations. This work is led by Dr. Blattner for IHV-Nigeria and IHV’s Dr. Bob Redfield, head of our Clinical Care and Research Division. Bob has PEPFAR funding in Ethiopia, Guyana, Haiti, Kenya, Nigeria, Rwanda, Tanzania, Uganda and Zambia.
I believe in one way or another they are collectively involved in helping more the 750,000 people overseas and care for more than 5,000 people here in Baltimore living with HIV.
AL: Several sessions were dedicated to anti-HIV vaccine research. Your institute is deeply involved in this research: what are the recent advances?
RCG: I will begin to answer this question by speaking for the field rather than just IHV.
As to the entire field, the advances I believe are most important are a gradual coming to a consensus that certain types of antibodies are the key to an HIV preventive vaccine. Along those lines the discovery of and production (via monoclonal antibody technology) of broadly neutralizing anti-HIV antibodies, that is antibodies that interfere with infection by numerous HIV variants in laboratory testing.
Similarly, we have more recent evidence of protection in monkeys with a vaccine candidate that induces these kinds of antibodies. Specifically related to France, I would like to mention the interesting progress report by Morgan Bomsel from the Institut Cochin, Université Paris, who has produced antibodies. The vaccine she used consists of a portion of the HIV envelope protein, gp41, different from that usually used by others (gp120). Moreover, the kind of antibodies she induces are not like those of other groups that block all entry in cell culture experiments. Her antibodies appear to diminish transit across mucosal barriers.
Another advance which was described included a follow-up to the first success, although very modest, in a clinical trial. This was achieved by the collaboration of Asia, Europe and the U.S. in a trial called RV-144, which was directed by medical scientists from the U.S. Army (WRAIR) collaborating with clinical scientists in Thailand and with Sanofi-Aventis.
As to our Institute, we have an interesting HIV preventive vaccine candidate supported by the Gates Foundation.
Indeed it is one of the first vaccines to be supported by the Foundation which goes to clinical trials in the next year (phase 1). I must, nonetheless note that all these partial successes in animals or in man have a severe limitation. Though they induce interesting antibodies, the antibodies are short lived making the vaccines not very practical. We must solve the problem of the durability of the antibody response so we can really be giving insightful comments as to when we think there will be major progress.
AL: Among presentations addressing the biology of HIV, could you comment on the most important ones in your view?
RCG: I thought the most important presentations, as mentioned above, had to do with antibodies.
In this regard the presentations of Peter Kwong and Ed Berger, both from the U.S. National Institute for Allergies and Infectious Diseases, stood out in my mind as giving us additional, deep insights into the nature of the B cell immune response to envelope antigens (portions of the envelope that give rise to different kinds of antibodies).
The science in this area is advancing at such great speed due to these people and others in the field that it is getting difficult to even follow.
I also thought that the presentation by Andrea Cerutti, of Mount Sinai School of Medicine, was innovative and important, and for me, really quite new. This had to do with the involvement of neutrophils in the antibody response and contributing to the duration of antibody response.
It is something I had never paid attention to and could be very valuable to those developing an HIV vaccine.
AL: What are the main take home messages of this year’s meeting of the IHV?
RCG: That the science, right now, is better than ever and that there is a turn-around in attitude about a preventive vaccine, which seems to be more positive, and finally the inspiration that prevention may be possible by education, testing and far more available therapy.
By reducing the titer of virus in infected people the epidemic could be controlled.
Yet my enthusiasm is tempered by the fact that this will take patience and serious long time commitment by governments during a time of financial difficulties. Its ultimate success will be hard to predict.
Finally, also, I’d like to recognize you, Alain Lafeuillade, for your great clinical insights.
Key words: Gates Foundation, HIV prevention, HIV treatment, HIV vaccine, PEPFAR