News | In the test tube: three decades of HIV vaccination

Dr. Kenneth Mayer is a professor of Medicine and Community Health and the Director of Brown University AIDS Program. The Daily had a chance to sit down with him before his keynote address at McGill’s World AIDS Week last Friday.

The McGill Daily: You were one of the first clinicians in Boston to see HIV patients. Can you tell me about it?

Dr. Kenneth Mayer: I was studying infectious diseases at Harvard in June 1981 when the first announcements of what came to be known as AIDS were in a weekly paper. I said, “Huh, here they’re seeing this epidemic of these immunodeficient conditions in men who have sex with men. Hmm, I wonder what the connection is here.” In the beginning, there was a competing hypothesis, the Fast Lane hypothesis: Some of the first people who got sick were people who had lots of sexual partners, but they also used lots of drugs…[so] the immune system doesn’t have a chance to process everything, and to fully recover. And the other hypothesis was, maybe there’s some new bug that’s destroying these people’s immune systems. And it took about three or four years to figure that out.

MD: I hear you’re working on a vaccine. What’s the deal?

KM: The vaccine is the highest priority because vaccines are the only things that have really stopped epidemics in their tracks in the modern era. So, for example, smallpox now only exists in vials that the U.S. Government and the Russian Government have. The trouble with HIV is manifold in terms of trying to find the vaccine. [For example,] there’s not a really good animal model…there have been a number of times where something has worked in protecting chimps and it hasn’t worked in protecting humans. So we can’t totally trust animal data. To do the human studies, to them ethically, is very challenging. You have to get people who are at risk for becoming HIV infected. They have to be aware of [their risk] enough themselves, and then ethically, you have to have them sign an informed consent [form]. So you’re really trying to fight against them becoming infected. To do a big vaccine study, it requires on the order of 5000 people. A study like that will cost tens of millions of dollars. Because of these factors and [the fact that] the virus is so tricky, the vaccine field, it’s like Sisyphus rolling the boulder up the hill, and this last year the boulder rolled back down the hill. The [last] vaccine was not protective.

MD: When you first encountered the virus, did you realize the magnitude of the threat it presented?

KM: Within a year, I started seeing people who weren’t particularly risky themselves: their partner partied a lot [and] they hadn’t. And that said to me, “Gee, if this can be transmitted in this kind of setting…this thing could really take off.”

MD: I hear you’re working on a vaccine. What’s the deal?

KM: The vaccine is the highest priority because vaccines are the only things that have really stopped epidemics in their tracks in the modern era. The trouble with HIV is manifold in terms of trying to find the vaccine. [For example,] there’s not a really good animal model. To do the human studies ethically is very challenging. You have to get people who are at risk for becoming HIV infected. They have to be aware of [their risk,] and then, ethically, you have to have them sign an informed consent [form]. To do a big vaccine study, it requires on the order of 5,000 people. A study like that will cost tens of millions of dollars. Because of these factors and [the fact that] the virus is so tricky..It’s like Sisyphus rolling the boulder up the hill. And this last year the boulder rolled back down the hill. The [last] vaccine was not protective.

MD: What advances have we made in fighting HIV in the past two decades?

KM: The advances are incredible. We’ve taken something from being a death sentence for 95 per cent of people who were infected, and have transformed it to a manageable infection. The biggest challenges are that there’s still more infections every year than there are people going on medicine, and the death rate is still very high.

MD: What would you advise an ordinary student in Canada to do to dotheir part against the epidemic?

KM: Understanding how HIV is transmitted and protecting
oneself and protecting one’s partners. Normalizing the conversation around safer sex with one’s friends so that people feel like you can be intimate and you can be sexual but you don’t have to transmit or acquire HIV. Getting tested, encouraging friends to get tested. Supporting global initiatives.

MD: Do you think that we’ll see the eradication of HIV in our lifetime?

KM: Probably not mine, maybe yours.

– Compiled by Ariel Lefkowitz


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