AIDS at 30: Vaccine now in local trial shows promise

Advancements in treatments, ongoing prevention efforts give researcher hope for a world without AIDS

JAMES BRIGHT | Contributing Writer
editor@dallasvoice.com

HIV and AIDS: These two abbreviations require little explanation.

They have been on the minds of any sexually active person for the last 30 years regardless of gender, age or sexual orientation. Those six letters have produced fear in the uneducated, the disease they represent running rampant in impoverished communities and most of sub-continental Africa.

Thirty years ago, if a doctor diagnosed a patient with AIDS, it was essentially a death sentence — a quick death sentence. No one knew that they were dealing with and no one really knew how it spread.

The virus has been responsible for more than 25 million deaths since 1981, with 1.8 million dying in 2009 alone. It has decimated communities and is the scourge of entire continents.

In Dallas County a third of the people with HIV will have a diagnosis of AIDS in a year.

There is no known cure for HIV/AIDS, but doctors around the world are working tirelessly to eradicate the virus.

Dr. Mamta Jain, director of HIV Research at UT Southwestern and acting medical director for HIV Services at Parkland Hospital, is one such doctor. She is currently involved in a trial vaccine that researchers hope could destroy HIV/AIDS in the U.S.

The HVTN 505 study that Jain is a part of is not actually up for FDA approval. But the knowledge gained from the tests could lead to a comprehensive vaccination, researchers say.

The important information is in the viral loads taken from candidates trying the vaccine. A reduced viral load in someone who is HIV-positive could delay the symptoms of the disease, giving the person a longer life and better quality of life.

The results of the trial will be a study on the rate of viral load changes between those who had the vaccine and those who didn’t.

The virus itself works by reducing the amount of cdT-cells in the body, which are responsible for fighting infection. If a person has HIV and his cdT-cell count drops below 200 they are considered, at that point, to have AIDS. All participants are HIV-negative.

Jain said trials of the 505 vaccine involving monkeys are being done at the National Institutes of Health and that results look very promising so far.

But it’s just the beginning.

“Models are models. Until you look at it with human beings you don’t know the full potential,” Jain said. “Every little step gives us a better understanding of what type of vaccine will work. That’s why we need volunteers.

“Until we try this vaccine and see the impact of it we won’t know how it works. It’s that knowledge that drives HIV study.”

Jorge Diaz is one of the trial’s current participants. He said his only incentive to try the vaccine was to help the community. Diaz just recently finished his last injection and said the whole ordeal was not really all that taxing.

“The only thing really rigorous about the trial is the amount of blood drawn,” he said. “The first time, they took 18 vials.”

Diaz said he suffered no side effects, and he thinks 505 could lead to an all-encompassing vaccine.

But while this vaccine may help to stop AIDS in America, it probably won’t do much for the African-born strain of the virus.

“There are different clades of HIV,” Jain said. (A clade is defined as a group consisting of an organism and all its descendants.)

“There are different things circling the African sub-continent,” Jain continued. “They are doing trials in Africa, so they can gain a better understanding of what vaccine would need to be there.”

Although not there yet, Jain said the 505 vaccine is definitely positive step forward toward complete understanding of HIV and its transmission.

Other advancements

Vaccinations are not the only area, Jain said, in which advancements have been made in the fight against the HIV/AIDS epidemic.

“In the last 30 years we have seen a tremendous amount of energy and support go into developing life-saving drugs,” she said.

At Parkland, Jain said, she has had patients that had a cdT-cell count below 200 who, with the right medicine, have improved their count to above 500 in a couple of months.

The work of researchers and doctors since the virus was discovered has transformed HIV from being uniformly deadly into a chronic, but manageable disease, Jain said.

Now if someone is diagnosed with HIV/AIDS at 20, they could live an additional 50 years using the right anti-retroviral.

This is a far cry from 30 years ago when people were dying six to eight months after being diagnosed.

Jain noted that while the earliest medicines used to combat AIDS were highly toxic, “We have better medicines now. If someone gets infected, we have incredible drugs to help them live a healthy life.”

There are pills now that can only need to be taken once a day and have very few side effects, especially compared to the old drugs. The new medication makes it easier to live with the virus since people don’t have to take pills every eight hours.

Despite these improvements, Jain said she has seen people who will stop taking their drugs for various reasons.

“Sometimes they lost their insurance and don’t have resources [to buy the medications],” she said. “Sometimes they feel OK and just don’t want to take them.”

AIDS is a psychological disease as much as it is physical, Jain said, adding that she has seen patients she’s had for years who are doing well but then will just hit a time where they stop taking pills due to pill fatigue.

That’s why Dallas service providers need to focus more attention on counseling, she suggested.

Jain said the LGBT community is largely responsible for much of the progress in the battle against AIDS.

“A lot of credit has to go to the gay community, which was there in the early days,” she said. “They played a very important activist role by trying to generate focus, energy and funding. With out that work we would not be where we are today.”

Jain cited viral Hepatitis-C as an example of what HIV/AIDS could have been without the activism of the LGBT community. Viral Hep-C affects more people, she said, but does not have the resources behind it that AIDS research does.

Looking ahead

Despite such improvements in treatments and advances in the search for a vaccine, the battle against AIDS is far from over, according to Jain.

“We can make tremendous improvements in people’s lives, but 20 percent of HIV-positive people in the U.S. don’t know they have it,” she said.

Because people could be infected with HIV and yet remain asymptomatic for years, the virus can do silent damage as it remains untreated — and they could pass it on without realizing it.

That’s why, according to Jain, the Centers for Disease Control has recommended universal testing.
Diaz agreed that testing is paramount.

“People should get tested every six months if they’re sexually active, and even if they aren’t they should be tested once a year,” he urged.

Jain said testing has been invaluable in virtually eliminating mother-to-child transmission of the virus in America. Every pregnant woman in the U.S. is tested for HIV and if she is positive, she can be put on powerful anti-retroviral therapy that can keep her from passing the virus to her unborn child.

Other areas of prevention

Aside from the vaccine, Jain said, work in other areas of prevention has yielded positive results.

“We know that behavioral risk counseling works and we also learned that circumcision can help resist the risk of HIV infection,” she said.

These methods are not 100 percent effective, though, and education about the virus is key to winning the battle. Transmission is not as prevalent in the LGBT community as it once was, according to Jain.

“The gay community has a great connection, and I feel like if I diagnose someone in the gay community they know where to get help,” she said.

Diaz agrees. He said he’s seen ads in publications like the Dallas Voice alerting people to where they can get tested and where they can get help. Some clubs even have free testing on Saturday nights.

The greatest rise of new HIV/AIDS positive patients has been African-Americans, Jain said.

This runs congruent with what Diaz said he is seen as well. He said men who don’t consider themselves to be gay but still have sex with other men can contract the virus and then pass it along to wives and girlfriends.

“Since they don’t see themselves as gay, they are not getting tested,” Diaz said, adding that it is vital to get information about testing and prevention to these groups. He suggested a hot line for those who don’t label themselves as gay, so they can get the proper information.

There have been some communication efforts with these groups though. Jain said she has seen a slow and steady decrease in new cases. This could be a good sign according Jain.

“It’s not a failure,” she said. “If we are testing more people and catching it earlier we can change the trajectory of their lives.”

Although not there yet, the dramatic changes in prevention and treatment of the virus have lead Jain to believe that there will one day be a world without HIV and AIDS.