(Portland scientists continue their trend in vaccine development breakthoughs.)
By: Sarah Glass @SASzilla
Portland Oregon is the epicenter of the world’s reseach on the human immunodeficiency virus, HIV. Dr. Louis J. Picker, head of the Division of Pathobiology and Immunology at the Oregon Health and Science University (OHSU), and his team have been the belle of the ball on World Aids Day since 2013, when the team cured SIV in a number of rhesus monkeys that are still disease-free today. “The vaccine stopped the infection from spreading and then cleared it from the bodies of half of the monkeys it was tested on,” Picker said in an OHSU press blog, “And we’re quite confident that this vaccine approach can work exactly the same way against HIV in humans.”
SIV, or simian immunodeficiency virus, is the equivalent of HIV in monkeys, making our cousins the perfect research subject surrogates in the search for a HIV cure. According to a report in Health News,”Picker also announced… trials to test a tuberculosis vaccine on monkeys, based on the design of the successful SIV one.”
December first marked the twenty-seventh annual World AIDS Day. Dr. Picker has re-set the bar for HIV research again this year, reinvigorating hope for a cure around the globe. While there are many reasons why HIV has been an elusive adversary, the Picker team has revealed an important strategy from the virus’s playbook. Their discovery has shed a new understanding on how the disease has been able to hide from the body’s security guard cells called CD8 “killer” T cells. With this knowledge, researchers may be able to find a way to reach HIV wherever it goes, and proceed to destroy it.
Creating a vaccine is the process of stimulating the body’s defences.
One of Picker’s colleagues at OHSU, and leader of his own vaccine development team, Dr. Jonah B. Sacha, and healthcare professional and Africa traveler, Dan Sorenson, agree to speak with me on the subject. Their correspondence reveals the real face of HIV, as well as the science and difficulties that researchers face today from development to patent, production, and beyond.
Creating a vaccine is the process of stimulating the body’s defenses with a weakened or dead strain of the target virus. Once humans are infected with it, just as with any chemical reaction, the body tries to even out the equation by creating antibodies to destroy the virus as a response. Vaccines are developed for HIV all the time. The issue is the genetic variation of its progeny. By the time a vaccine can be manufactured to combat one HIV strain, the virus had already copied itself thousands of times. The vaccine will be able to destroy some of the copies, but others are different enough from the original that the it will have no effect. “One of the biggest stumbling blocks to a HIV vaccine is the sequence diversity of the virus,” says Dr. Sacha.
Experiments with animals, monkeys and mice in particular, presents another hurdle for scientists. “Is it hard to get results helpful to humans from your research on animals?” I ask Sacha.
“A rule of thumb in the field,” he says, “is that mice lie and monkeys exaggerate. With that said, a lot of big advancements have come from monkeys — Tenofovir, one of the biggest antiretrovirals, for instance. The humanized mouse model has a lot of issues and really isn’t a great model for HIV. Given how genetically and physiologically similar monkeys are to humans, they are the preferable model.”
I ask, “How will developing a cure for HIV be the same or different from what Dr. Picker has achieved with his vaccine?”
Says Sacha, “If creating a vaccine is scaling Mt. Everest on earth, a cure is scaling Mount Olympus on Mars. The field has been trying to create a HIV vaccine for thirty-five years. Curing HIV is even more daunting. Frankly, I am unsure it is even possible as it parallels cancer very closely. We can get people into remission, but never really say “cured of cancer.” It is the same issue with HIV. As the saying goes, absence of detection is not the same as detection of absence.”
“Can you expound on Dr. Picker’s latest discovery of what he calls a HIV ‘sanctuary’?”
“The B cell follicle is a region of the lymph node where you essentially need a key to enter. Infected CD4 helper T cells (Tfh) have the key and thus can enter the site. The problem is that the CD8 killer T cells do not have the key to enter. Thus, infected Tfh can enter the B follicle and remain safe from being killed by the killer CD8 T cells,” Dr. Sacha says.
Changing the subject to research politics, the infamous CEO of Turing Pharmaceuticals, Martin Shkreli in particular, I ask Dr. Sacha if scientists can help safeguard against people like Shkreli by choosing to work in publicly funded facilities instead of privately owned companies. Earlier this year, Shkreli realized his company held a monopoly on a drug meant to help HIV patients called Daraprim. Taking advantage of the situation, the CEO incited pubic outrage across the country by raising the price for the drug five-thousand percent.
“Sadly,” Dr. Sacha says, “once the patent is licensed, it is out of our [researcher’s] hands. That is just the way the system is set up. Martin Shkreli has no ethics.”
Dan Sorenson picks up the conversation just outside of the OHSU laboratory doors where Dr. Sacha bids adieu. As well as being an EMT and ER nurse for over fifteen years at Hamilton Montana’s Marcus Daily Hospital, Dan also spent time in the African province of Zimbabwe a few years after the first cases of HIV became known in the U.S.. “The differences in Africa versus here are most prominent when it comes to perception and approach to treatment. Here in the U.S., it’s a BIG deal,” Sorenson says, “It’s a death sentence and carries with it such a negative stigma. You are automatically considered a carrier of disease and questions always seem to swarm about your sexuality and your possible drug use and just how perverted are you if you have HIV.”
Most would agree that this paradigm has existed since the CDC (Center for Disease Control and Prevention) decided to note the “homosexual” orientation of the first reported case subjects to contract “cellular immune-dysfunction… acquired through sexual contact” in 1981.
Today, while American history can agree that HIV and AIDS have certainly effected the gay community, theCDC’s most recently available statistics for HIV in the U.S. claim that “homosexual and bisexual men represented only 54% of people living with HIV in 2011.”
One young woman shows it doesn’t take being homosexual, Charlie Sheen, Freddie Mercury, or in Africa to be affected by HIV. Going only by the handle Skinned on an online forum, she posted the following about her HIV diagnosis:
I got HIV at 17. Last year, actually. Last year, I also first lost my virginity. I got HIV from being ignorant and selfish. I just thought this carnival worker was cute and he thought I was cute and it turned out he had HIV. He called me a few months later and told me. I knew I had it. I got tested twice positive and now I am supposed to be taking these enormous pills but I CAN’T take them. I really am unable to… I’m also afraid the medications they give me have worse side effects than they do help. Liver damage? May lower your CD4 count? WTF? That’s like depression medication. ‘May cause suicidal thoughts.’ Anyway, I don’t want to die painfully. I want to die calm in my sleep beside my husband. I hope I die of old age before I die of AIDS.”
“Here we keep our HIV patients alive as long as possible,” Dan Sorenson says, “The medications are very expensive but have shown that they are quite effective in prolonging life. In Africa there does not exist the wealth. The most significant difference, in my opinion, is in how our cultures see HIV. Mind you I was in Africa in 1991, but I don’t believe it has changed much since. The attitude there seems to be ‘Well, we’re going to die anyway because Africa is a tough place.’ The people who put us up said their best guess was that one-hundred percent of the Zimbabwe military personnel were HIV positive. They don’t believe in prophylactics. The routine for the military person in Africa is to work during the day and at night go out and have multiple sexual partners without concern for the risk. Their culture is not the same as ours and concerns over the spread of disease do not prevail over the concerns for ‘pleasure while we are here.’ At one point I asked my host why the natives that lived on his property had so many kids (usually fifteen or more per family). He said that he had asked several the same question and the answer was always ‘That way if a bunch of them die it isn’t a big deal.”‘
Looking at the statistics, it can appear there will never be an indemnity against pain or loss. They span across cultural boundaries, sexual orientation, and race. World AIDS Day calls on us to remember the needless suffering of others and reconsider how to traverse the obstacles that separate the present from a disease-free future. While the road may end in Africa with a cure, the cutting edge research being done by the OHSU vaccine development teams here in Oregon is the real front line in the world’s battle against HIV. Until that time when this war is won, surely it will be here and against such as the works of Dr. Louis Picker and Dr. Jonah Sacha that the world will measure it’s progress.