July 17, 2020

HIV set the stage

In the early 80’s young, previously healthy gay men started developing rare infections and cancers, ultimately dying from them. This was an unknown and new disease that was terrifying because it started invisibly and developed insidiously. The virus causing this disease, AIDS or Acquired Immunodeficiency Syndrome, was finally identified in 1984. Once the Human Immunodeficiency Virus (HIV) was ID’d, hopes rose that a vaccine could be ready after a couple of years. We are still waiting after 36 years. The vaccine for the HIV virus, which was from a recently identified class called retroviruses, has proved elusive. It isn’t because we haven’t tried. The search has never ceased. Multiple approaches have been tried. In the meantime, scientists have learned how HIV attacks the immune system, how to suppress the virus with medication to keep someone’s immune system intact, how to block it’s entry into cells with medication to prevent infection. But a vaccine and an easy cure have not occurred.

There is some promising data from one of the first vaccine trials to prevent COVID-19. The good news is that it seems to induce a good immune response towards the spike protein which is how SARS-CoV-2 attaches itself to human cells. So far, it was tolerated well and seems to boost immunity. But it has only been given to 45 patients so far. It will need to go into phase 2 trial to look for efficacy and side effects and be given to many more. The big result we want is long term immunity. We will have to wait for awhile to see that data. We still don’t know enough if this will work. But it is a start.

We are lucky that we have this long experience looking for vaccines and treatments for HIV. The infrastructure already exists to help these trials get underway. HIV is a unique virus that infects our cells by attaching to the CD4 receptor of a certain type of white blood cell. The research into looking for a cure or treatments for HIV taught the world more about viruses and their uniqueness than almost anything else. This article explains the differences between coronaviruses and HIV and why success to find a vaccine for SARS-CoV-2 is possible, partially due to the legacy of that research.

I have been lucky enough over the years to work with some of the clinical trials for HIV treatments and know these scientists are hard at work and are dedicated to success. To add to our knowledge, the New York Times has this nice piece about possible treatments for COVID-19- the evidence of what works and what is safe and what may not be.

Yes, we are making progress in treatments, but not a cure, and we have a long way to go on the vaccine. This means we are still talking prevention. It is so hard when so many opt not to wear masks and many leaders actively discourage mask wearing. So disappointing. This Washington Post article has data that shows, actually not surprisingly, people against wearing masks are more likely to get infected. Another helpful tool is this map from the New York Times showing where people are wearing masks and where they are not.

Our best options for prevention are social distancing and mask wearing. We need to keep paying attention, so we know what is going on, when the data is reliable, how to stay safe, and which places to avoid so you don’t end up in risky situations.

Oh, yea, enjoy Queen Elizabeth knighting Captain Tom today. Watching it made me cry. There are good people in this world. We mustn’t forget that.

Wash your hands, cover your nose, keep safe six.