The first known case of HIV in a human dates back to 1959, but the AIDS epidemic that we know of today began (officially) in 1981. In the short three decades or so since then, many strides have been made in the fight against HIV and AIDS. Educating the masses about the importance of safe sex and regular STD testing, fighting the stigma that burdens people living with HIV, and researching the virus itself are ways to fight back against HIV and AIDS. There are some truly remarkable individuals striving to improve the quality of life for those living with the virus now and laboring to find a vaccine and a cure.
We wanted to highlight some of the crusaders in this actual life-or-death battle by giving them a chance to speak to the world about exactly what they do and why they do it. This series of interviews focuses on three voices: A scientist, an activist, and an advocate. We hope that the tireless work of these three individuals inspires and ignites something inside each of our readers.
The Scientist: Dr. Stefanie Homann, Ph.D.
Dr. Stefanie Homann, Ph.D., is a virologist who is currently working as a researcher at the University of California of Los Angeles. She earned her Ph.D. from the University Hospital of Heidelberg, Department of Infectious Diseases, in Germany and is very well known in the scientific community for her work as Scientific Director of the AIDS Research Alliance and the research she conducted while at the University of California – San Diego’s Department of Medicine as a postdoctoral fellow.
I had the honor of speaking with Dr. Homann about her work and what drew her to the field of HIV research:
Kristena D. (STDcheck): “You are a virologist; what exactly does that mean and how did it lead you to the study of HIV?”
Dr. Stefanie Homann: “Virology is the study of viruses, so microscopic, tiny particles that cause infection. I was always fascinated by how a virus is able to use the host and its cells to replicate and multiply and establish an infection that is very pronounced. HIV specifically establishes mechanisms to circumvent the host’s immune system. A lot of viruses do have these kinds of mechanisms, but HIV and hepatitis are able to establish a chronic infection. They’re able to continuously infect the host and not be fought off by the immune system. So, I wondered ‘How can we work against this? How can we make the virus not impact us anymore?'”
KD: “Many people feel that it’s only a matter of time until HIV is cured. What are currently the biggest hurdles scientists face in the search for a cure?”
Dr. Homann: “Many organizations are working together all over the world to find a cure. We have over 30 years of data on HIV. The biggest hurdle is reservoir cells– they’re cells that become infected by HIV and go into a latent stage (not multiplying). It usually happens very early during the HIV infection; that’s why the Mississippi baby came back as HIV-positive after a while. People seeking treatment still have reservoir cells. Once they get off treatment, [it is comparable to] you getting the Flu– Your immune system fights off the pathogen, but it activates the reservoir cells. That means the virus starts replicating and the infection is activated again. Meaning we can’t cure HIV until we understand how these reservoir cells function.”
KD: “What does that mean for finding a cure?”
Dr. Homann: “We’re developing techniques to measure how big the reservoir cells are. We can find them, but they can also hide in lymphoid tissue- a great target cell for HIV. We cannot take someone’s tissue all the time for analysis. Blood is easy and convenient, but it’s not the only place where cellular reservoirs are hiding; it is difficult. The cells don’t have a certain marker; they look like regular T-helper cells. They’re dormant, so they don’t show that they’re infected. A lot of people use what we call a ‘kick and kill’ strategy which activates reservoir cells so that they become visible to the immune system so it can fight them. That’s the kick– You have to promote and support the immune system of the patients; stimulate the immune system so that it is sharpened and more sensitive to detect the reactivated cells.”
KD: “So, in ‘kick and kill’, is the ‘kill’ a cure?”
Dr. Homann: One approach that is difficult and a lot of people research is cytotoxic T-cells, which have been used for cancer therapy. They’re in your body and they detect cells that are infected (like cancerous cells) and they usually kill everything that’s not the body’s own including foreign or damaged cells. But these cells are not as effective as they should be in HIV-positive patients; they’re a little slower and less effective. However, they can be taken out of the body, genetically modified, and given back, so that the cells can do their job. After the ‘kick’ that activates the cellular reservoir, these cells would go back in and kill reservoir cells, eliminating the virus. That could possibly cure HIV, but the cells are so rare and so difficult to detect due to hiding.”
KD: “Are there any innovations or new concepts that could cure the disease that people may not know about?”
Dr. Homann: “There are different levels and approaches to curing the virus. As far as a sterilizing cure that completely rids the body of the virus–which is what looks like happened to Timothy Brown, the ‘Berlin Patient’–this method just is too risky and has too many problems. For a functional cure, where people can get off of treatment without the virus coming back and rebounding, the immune system needs to be in a situation where it is stable, effective, and tough enough to fight and keep the virus in check without having to take treatment or medication.”
KD: “How close are we to a functional cure in terms of what’s going on in the scientific community?”
Dr. Homann: “Besides the ‘kick and kill’ method, there are people working on trying to use stem cells. They produce the cells in your blood system that become infected by HIV and scientists are trying to genetically modify these cells, so they’re resistant and cannot be infected. That’s a huge approach and there are clinical trials. It’s going in small steps because these are very big studies and experiments. You have to take bone marrow and modify it, then put them back in the patient and engraft. They have to stay there and survive and replace your regular cells in the blood stream. It’s a very difficult undertaking. About two years ago, a group in Oregon came out with a new vaccine that has been tested. It is the most promising result we’ve seen for a vaccine. It isn’t all done and ready, but it looks very promising. A very large number of animals were protected using this new vaccine. It works with a different background than vaccines we’ve used before.”
KD: “In the past 30 years, we’ve come so far, but there are people who feel that there should be a cure already. There are even conspiracy theories. Does this impact the scientific community?”
Dr. Homann: “Something important about the last 30 years– By studying HIV and using these different approaches and different angles–trying to get to the virus and eliminate or compromise it, or get to the immune system so we can become immune or resistant to the virus–we didn’t just gather info on the [human immunodeficiency] virus. We got a lot of insight into the immune system and the human body. A lot of machines and tools and techniques were developed because of the research done with HIV. It contributed to our general understanding of cell biology.”
KD: “As a scientist, are there any misconceptions or things that need to be addressed about the fight against HIV?”
Dr. Homann: “Quite a few factors play into misconceptions. I don’t believe in the things that some people say, things like ‘HIV is caused by pharmaceutical industry’. There’s enough evidence of where it came from and what led to the epidemic. An HIV patient in the mid-80s might question why we now have no cure and why so many people have become infected over the last 30 years. I get that. As a researcher, this virus is very tricky and has so many mechanisms to circumvent the immune system. There is no one way to isolate it and eradicate it. Researchers are working hard to find something, anything, if not a cure. We’ve made huge milestones developing antiviral therapies. In the beginning, there was AZT [(the drug Retrovir)] and people had horrible side effects, but it was all we had. Now we have over 30 medications and therapies to treat the individual. We’re extending lives. Nowadays people do live– almost to the same age as unaffected individuals! It really has improved a lot. It’s not the ultimate goal. We want to have a vaccine and cure the infection for people who are HIV-positive, but it depends on a lot of researchers, especially in non-profit and academia. They’re depending on funding. Grant writing takes up a lot of time you could be spending in the lab doing research.”
KD: “Do you think that’s due to the epidemic seeming less dire than it was 30 years ago, in part to new treatments?”
Dr. Homann: “It was far more present in peoples’ minds years ago. Nowadays, the general population knows it’s there, but it’s not as present. HIV and AIDS Awareness Day is once a year and other than that, you don’t hear too much about it. I think people put it in the back of their head, though I think they should be aware always–especially in high risk populations. One big key to reducing the rate of infection is for people to go and get tested, for people to know if they’re positive and get medication and help. It helps not just their lives, but other people to not transmit it further. The work we’ve done, the work you do at STDcheck, the work of activists trying to make people aware–the importance of using condoms, getting tested–it is for a purpose. It’s a big thing that people have to keep in mind; even though they can live longer, at this point they will have it for the rest of their lives.”
At STDcheck.com, we offer safe, reliable, and confidential HIV and STD testing services at affordable prices to ensure that people, especially those who are young or at a high-risk, have access to necessary healthcare that gives them the knowledge and power to protect themselves. Our blog, Exposed, was created to provide accurate, vital information about sexual health in an interesting and informative way.