Continued Support

Investments in research, which made the HIV virus the most well-understood by science, must continue so that the three main challenges related to AIDS can be reined in, according to INCT-iii's Esper Kallás

By Fábio de Castro

Agência FAPESP – HIV is the most well-understood virus in science today, due to large investments in research over recent decades. The countless achievements have vastly improved the lives of people carrying the virus, but there is still a long way to go if the HIV-AIDS epidemic is to be controlled.

This is the opinion of Esper Kallás, professor at the Universidade de São Paulo Medical School (FMUSP) who organized the 6th Advanced Course on HIV Pathogenesis in São Paulo last week, where topics such as treatment, vaccine development and the epidemiology of the virus were discussed.

The course, which brought 30 of the world’s main HIV specialists to Brazil, was part of the activities of the National Institute of Immunology Studies (INCT-iii), whose HIV-AIDS area is coordinated by Kallás.

The INCT Program was started in December 2008 by the Ministry of Science and Technology (MCT), by way of the National Council of Scientific and Technological Development (CNPq), with resources obtained in partnership with state research support foundations. FAPESP finances 50% of funding directed toward institutions based in São Paulo State.
 
According to Kallás, the material presented by specialists during the course showed that discoveries related to the varied aspects of the AIDS virus have not stopped in recent years (and have in fact effectively improved the life of patients) but still need to advance.

“The advances made since the AIDS syndrome was identified have been immense, but we still have three big challenges ahead of us. The first is to develop a preventive vaccine. The second is to understand the degenerative mechanism and combat aging in carriers. The third is to discover how to cure individuals. When we’ve met these three objectives, we can control or eliminate the epidemic,” he told Agência FAPESP.

According to the scientist, investments in HIV research, which have always been considerable, need to maintain the same levels if these goals are to be reached. “HIV is definitely the virus we know the most about today due to the amount of investments in research. But there must be follow-through. It’s also important to observe that resources invested in AIDS research don’t just stay in their areas, but end up multiplying into other areas. We can’t forget that this type of investment is mostly made over the long term, in human resources education, the dissemination of knowledge and training for study groups,” he pointed out.

The situation for patients today is very different than it was at the beginning of the epidemic in the 1980s, according to Kallás. But this doesn’t mean that the disease can be met with indifference.

“Back then, being infected with the virus had much more dramatic impact. Today, it’s different, but the illness still can’t be ignored. It still has a very large impact in terms of public health, individual health and even financial cost issues. Patients’ conditions have improved greatly compared to before, but there is still much to be done,” he affirmed.

Trial vaccines

During the course, a revision of HIV pathogenesis was presented to the students, doctors and other participating professionals. But the most important aspect of the course was to gain knowledge about data from recent studies performed by the presenting scientists.

“We had the opportunity to see the cutting edge knowledge about HIV pathogenesis in relation to transmission, prevention, the immunological response, virology and infection treatment,” said Kallás.

There have been important advances in all these areas recently. “On the prevention question, for example, we had a presentation of the most recent data on Pre-exposure Prophylaxis (PreP) of the virus. In immunology, nine new cellular subpopulations involved in the immune response were identified,” he affirmed.

In the area of recognizing the biodegenerative aspects of HIV infection, the course also offered discussions on cellular senescence and activation markers. In virology, the identification of new targets for antiretroviral action and cellular defense mechanisms were presented.

“We also discussed new data on the genetic diversity of HIV and new HIV distribution and transmission data for Brazil and the rest of the world. In terms of treatment, we discussed development of new drugs and debated special situations such as acute infection or people who don’t respond with elevated levels of T CD4 lymphocytes.  There were also lengthy discussions on the question of resistance,” said Kallás.

In the area of vaccines, recent results were presented by a number of groups with experimental candidate vaccines to combat HIV transmission. Some of the main bottlenecks in the scientific advancement of immunology were also debated.

“One of the bottlenecks is that we still have no well-defined marker for protection. We haven’t been able to precisely say, based on a specific test, if a person will be protected or not. Secondly, the virus is very diverse, changes greatly from person to person. It is even different within one individual. It is difficult to identify and recognize these viral variations,” he said.

Another bottleneck pointed out by Kallás is that it’s still not known exactly which region of the virus and type of response would in fact manage to generate protection. “There have been a number of attempts, we know some things but we still haven’t defined it with certainty. Many advances were presented and helped us to understand some of these problems, but we still have a long way to go,” he said.