The HIV research evolution
Interactive timeline: HIV/AIDS research evolution
More than three decades of dedicated research on HIV/AIDS has led to great discoveries and advances in the HIV response. In recognition of the day that the first AIDS-related deaths were reported on 5 June 1981, four scientists working in four different parts of the world reflect on the evolution of the HIV research field, their most significant moments and predictions for the future of HIV research.
Anthony S. Fauci, M.D., is an immunologist and director of the National Institute of Allergy and Infectious Diseases (NIAID) in the United States. He has been working in HIV since 1981.
I have worked in the HIV field since mid-1981, and this has provided me with a unique opportunity to see how the HIV research field has evolved globally. The discovery of the virus was certainly a massive landmark and opened up a whole vista of research possibilities.
This varied from areas such as the description of the virus to the development of antiviral drugs in the mid-’80s, and the approval of azidothymidine (AZT) in the US in 1987. Those advances were dramatic and transformational, but we were looking only at the tip of the iceberg and were not appreciative of the extraordinary scope of the epidemic.
The fundamental questions, if not completely answered, have been very robustly addressed. The evolution of fundamental discoveries led us to have drugs that can essentially transform the lives of HIV-positive individuals and reduce infections.
A personal milestone relates to the bridge between science and policy, and my role in the President’s Emergency Plan for AIDS Relief (PEPFAR). President George W. Bush had the vision to do something impactful, particularly in countries that did not have the capability or resources to address this terrible epidemic. So together with colleagues and staff within the White House, we made recommendations that ultimately created PEPFAR.
In terms of the future of HIV research, an effective vaccine will be massively important. If we combine an effective vaccine with other combination prevention modalities, I believe that we can turn the dynamic of the global epidemic.
Quarraisha Abdool Karim is an infectious diseases epidemiologist based in South Africa. She has been working in HIV since 1989.
I think a significant milestone in the evolution of HIV research has been how opportunities for young researchers have changed significantly over the years. The whole approach to engaging young researchers changed around 2005 with increased recognition by more senior scientists that the new generation of emerging scientists brought with them valuable and innovative ideas. The importance of engaging young people in this new cadre of researchers manifested itself in a number of ways, such as through the creation of scholarship opportunities by the National Institutes of Health Fogarty International Center and other similar initiatives.
Over the years, the resources available to young researchers has varied, but the notion of engaging young researchers is now quite entrenched, evidenced in youth science academies and dedicated space in journals for young investigators’ contributions.
The International AIDS Society is a good example of where young researchers are recognized and supported through scholarship programmes, awards, workshops and rapporteur sessions.
I believe that the HIV research movement has massively influenced research in other diseases and will continue to do so in the future. To strengthen health systems and health promotion, we need to pay more attention to the opportunities that exist in terms of expanding what we have learned from our successes in the HIV response. In order to sustain the gains we have made, it is necessary to look at how we can share experiences and integrate those experiences with other related conditions.
A key area in future research of HIV will be the use of antibodies. I believe successes in the use of antibodies will inform vaccine development and the cure agenda.
Praphan Phanuphak is a specialist in immunology, microbiology and internal medicine. He is based in Thailand and has been working in HIV since 1984.
The highlight of my career has been combining science and activism to respond to the demand for reasonable and ethical HIV care and prevention services. There are so many examples of this leading to tangible progress such as the establishment of the Thai Red Cross Anonymous Clinic in 1991, which offered access to HIV counselling and testing for at-risk populations without the fear of being identified. Then in 1996, the Princess Soamsawali Donation Fund was set up to provide up-to-date drug regimens to pregnant Thai women to prevent mother-to-child transmission (PMTCT) of HIV. This finally convinced the Thai government to provide three-drug PMTCT regimens to all pregnant women in 2010.
A major milestone for me personally, was the setting up of the HIV Netherlands Australia Thailand Research Collaboration in 1996. This led to ensuring that standard treatment was accessible to thousands of patients before the Thai government launched the large-scale ART programme at the 15th International AIDS Conference in Bangkok.
I think that many valuable lessons can be learned from this combination of science and research in the HIV field. HIV implementation research, such as differentiated service delivery models and community-led health services, can be applied to other health issues such as non-communicable diseases, mental health and illicit drug use.
Looking forward I think improved access in terms of long-acting antiretroviral therapy, delivery models and PrEP on demand will be very important in the HIV field.
Françoise Barré-Sinoussi is a Nobel laureate and French virologist known for co-discovering HIV. She has been working in HIV research in Paris since 1983.
I think that the discovery of ART and the combination treatment that we have today has been one of the major milestones in the HIV research field to date. This treatment has enabled us to control replication of HIV in patients since 1996 and, consequently patients have a life expectancy similar to non infected individuals. This would not, of course, have been possible without the earlier breakthroughs and increased knowledge of the virus, but this was the big breakthrough for patients.
The HIV research field has offered many career opportunities for young researchers both in developed and resource-limited settings, including wonderful opportunities in Africa and South Asia. This was quite rare in the past, particularly in the African context. The development of clinical and operational research, as well as large consortiums, has also provided networking and career opportunities for young researchers in the field.
I am a little concerned about the future as, increasingly, people think that the success of treatment and tools for prevention signify the end of the HIV epidemic, resulting in less funding and fewer career opportunities for young researchers in the HIV field. The next step is for the HIV research field to interact with other fields to create new opportunities for young researchers in the future.
Looking ahead, the identification of novel biomarkers to develop precision medicines and ultimately contribute to the development of HIV cure research will be a major future breakthrough for the HIV field.