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40 years of HIV and AIDS research

On World Aids Day, Professor Marie Laga talks about the main advances in the fight against the disease

We talked with Dr Marie Laga, ITM researcher and the Head of the Unit of Sexual Health including HIV, on the 40 years since the discovery of HIV-AIDS. We focused on the main advances made in the fight against this disease.

Dr Laga, can you tell us how you started researching reproductive health issues, including HIV?

I joined Institute of Tropical Medicine in 1984 to work in a project on Sexually Transmitted Infections (STI) in Nairobi, Kenya. We looked at the impact of STI on the health of mothers and their babies. That was exactly the time when HIV epidemic had been recognised, both in the North and the South. Congolese and ITM researchers were already very involved in understanding the HIV epidemic in Africa, so I was in the right place at the right time. 

What have been the main scientific findings made in the area of HIV since its discovery 40 years ago?

Antiretroviral treatment is without any doubt the most important scientific breakthrough, a real game changer. It turned the deadly disease into a chronic condition. After 40 years we still don’t have a vaccine, or a cure, but the search goes on. More recently, we discovered that ART can also prevent new infections by treating the HIV infected people early on. Giving pre-exposure prophylaxis (PrEP) to HIV negative people is certainly also very important. 

Although this is not a new topic, people still confuse AIDS with HIV. What are the differences between AIDS and HIV?

HIV is the virus, and AIDS the end stage of an HIV infection. The virus destroys the immune system and patients get opportunistic infections. They will eventually die if no antiretroviral therapy (ART) is given. But now that most people get ART as soon as an HIV diagnosis is made, we now rarely see the clinical picture of AIDS anymore. At least in Belgium, but also in Africa, even in the most affected countries, hospitals are no longer filled with patients in an advanced stage of the disease. 

Currently, many HIV-positive people are benefiting from antiretroviral treatment. When the treatment is well-adhered to, their viral load reaches undetectable levels. In scientific terms, how does this benefit the fight against HIV? 

The treatment is both reducing the AIDS related mortality, as well as reducing the number of new infections, because undetectable means untransmissible (U=U). The rate of new infections is declining worldwide, but HIV remains a global health crisis. In 2020 alone, 1.5 million people acquired the virus, a majority living in low- and middle-income countries.

The world continues to search for an HIV vaccine. What are the global advances in HIV vaccine research? What is ITM’s role in this?

The search for a vaccine is a story of one failure after another. It turned out to be much more complicated to produce a preventive vaccine than initially taught. HIV is not SARS-CoV-2, the scientific challenges to overcome are enormous. But maybe new insights used for SARS-CoV-2 vaccines, such as mRNA technology, may accelerate the chances to have an HIV vaccine. We have to keep trying, and in the meantime maximise prevention by combining all other methods we have. ITM has done basic research to provide pieces of the puzzle of HIV vaccines, to better understand the HIV viruses and the immune response. Now we are mainly focusing on PrEP, understanding how to optimise the roll-out to maximise the impact on the epidemic. And preparing for next generation of PrEP which will not require a daily pill but two monthly injections, or a once-a-year subcutaneous implant.  

What is the global impact of COVID-19 in the fight against HIV? And how can resources (e.g. COVAX mechanism for vaccines, testing, vaccine production), infrastructure (e.g. laboratories) and mobilisation (media campaigns, community engagement, civil society, etc.) generated in response to COVID-19 contribute to advancing the fight against HIV, especially in low- and middle-income countries?

The COVID-19 response has affected the fight against HIV in many ways. Prevention and testing services have been disrupted, but remarkably, access to ART remained relatively stable, thanks to the dedication of the “HIV community”. HIV positive people who are not on treatment have a higher chance of acquiring SARS-CoV-2. They present with more severe symptoms and a higher chance of dying of COVID-19, as was documented in South Africa. The HIV response provided some unique opportunities to address the COVID-19 pandemic. Flexible HIV funding mechanism set up by the Global Fund allowed for rapid action, laboratory infrastructure to do PCR, and distribution mechanisms used for ART now facilitate vaccine distribution. And of course, the civil society and the community-led responses which characterised the HIV response, are now being used in improve the COVID-19 response. It was frustrating to see how much time it took time for policy makers to realise how essential that is to access the most vulnerable groups in society.

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