“In an ideal world, within a generation or two, the AIDS virus would disappear because the 40 million people infected would take antiretroviral treatment rather than transmit it. Risk groups will also be protected. But in the real world, in 2022, 1.6. … millions of people were infected. A vaccine is still needed,” says Dr. José Alcami, director of the AIDS immunopathology department at the Carlos III Health Institute, one of the country’s leading experts on vaccines in general and in particular on the disease, the first cases of which have been identified. USA in 1981.
Since then, medicine has found treatments to reduce the viral load to a minimum. There are even four known cases of complete cure, which are “very exceptional, but cannot be extrapolated to the majority of patients.” What has not yet been achieved is finding a vaccine. This more than 40-year career contrasts with the achievement in just one year of a cure for covid. Alcamy will be in Bilbao today to talk about exactly this at the RiboRed 2024 Congress, organized by UPV/EHU researchers Isorze Santin and Ainara Castellanos, as well as Biodonostia, CIMA and the University of Salamanca. from yesterday and for three days to all researchers in the country working in the field of RNA. This will sound familiar because some Covid vaccines have been made possible by this technology.
– His conference is called “Why was the Covid vaccine created in less than a year, but we haven’t had an AIDS vaccine for 40 years?” Give us the answer.
– This can be explained by three reasons. First, unlike the HIV vaccine, the Covid vaccine is “easy” to make. It meets the immunological criteria of many others. Secondly, already known tools, such as messenger RNA, can be used. And third, vaccine approval rules were changed during the emergency.
– Why don’t these AIDS strategies work?
– The HIV vaccine poses a challenge that has never been faced before. In classic cases, it’s essentially about waking up the immune system to do what it knows how to do. But in the case of AIDS, it’s about teaching the defenses to do what they don’t know how to do. So this is a completely new challenge. Today we know that this is possible, but very difficult. We are now at a stage where completely new strategies are being proposed.
– Messenger RNA?
– We participated in some studies with messenger RNA, but its effectiveness was very low. The problem is that we do not have a vaccine design, we do not know what the “missile” should be that we have to develop to attack HIV and, say, be produced by the immune system. The day we get the design, RNA will be very valuable, especially in such a volatile virus. I think what will ultimately be successful is a combination of strategies. One of them is to awaken the virus when it is “sleeping” in its reservoirs. They then begin to multiply, and as the patient undergoes treatment, these cells will be destroyed. But this is not enough, since the virus can become resistant to the immune response. What is done is combined with strategies to strengthen the immune system.
The key to the virus
– HIV is a virus that hides its keys.
“In my opinion, the main difficulty it presents is the structure of the protein that surrounds it. This is the key they use to enter the cells. Antibodies produced during vaccination block the key. It’s like sticking some plastic on it that prevents it from entering the lock. The problem is that compared to other viruses like covid that reveal it, HIV hides it. This means that even if we have antibodies blocking the key, they will not be able to access it. And when they teach it to get into the cell, the space becomes so small that the antibodies can’t reach it because they’re too big molecules. It is also covered with a layer of sugars, through which they also cannot penetrate.
– In a 2002 interview with this newspaper, he said it was stupid to announce a date for an AIDS vaccine. WHO has set a goal of ending this pandemic by 2030. Is this real?
– Yes, but without a vaccine. In an ideal world, it will disappear within a generation or two because the 40 million infected will take antiretroviral treatment rather than pass it on. Risk groups will also be protected. But in the real world, 1.6 million people will be infected in 2022, mostly in sub-Saharan Africa. 25% of people still do not have access to treatment. These are the people who need the vaccine.
YouTube doctor who explains how vaccines work on Simpsons dolls
During the height of the pandemic, Dr. Alkami started a YouTube channel called Dr. Pepe’s Briefcase. In it, he explained questions about how vaccines work, how the pandemic is developing… He even used stuffed Simpsons toys to do this. It reached 6,000 subscribers. “I like to explain things. I give about 40 talks a year and needed to move to social media. An article from Nature shocked me in 2020. He said scientists must commit to communication. We were in the middle of what was called an “infodemic,” an overload of information from experts coming from everywhere. I have never met so many epidemiologists and virologists,” he recalls.