Prof Barré-Sinoussi... My dream is certainly to make sure that everyone is on treatment, whether it is novel treatment or the current treatment that we have today.

Prof Françoise Barré-Sinoussi, who won a Nobel prize for her work in first identifying HIV, tells The Star that she believes there will be a cure for the virus that causes AIDS by 2050. She will chair the upcoming 7th International Aids Society (IAS) conference from June 30 to July 3 in Kuala Lumpur.

THE 1980s saw the reign of showy prints, big shoulder pads and baggy parachute pants that look like you could stash your weekly supply of Twinkies.

Beyond its zesty-neon façade, the era harboured a new terror that was quickly seeping into its psyche.

It was the year 1981 when the United States became the first country to recognise that there was a strange new disease that was causing terrible and mysterious symptoms in clusters of gay men and injecting drug users (IDUs).

These symptoms include dementia, extreme diarrhoea, staggering weight loss and weakness, and were afflicting young and apparently healthy adults.

The public reaction to the phenomenon had been largely adverse, with many attributing the condition to an issue of morality. This reaction has undoubtedly contributed to the establishment of the disease, known today as the acquired immunodeficiency syndrome (AIDS), as among the most politicised, feared and most controversial medical conditions of our time.

In 1983, French virologist Prof Françoise Barré-Sinoussi finally put a name to what was causing the symptoms, when she discovered (with her former mentor, Luc Montagnier) that the human immunodeficiency virus (HIV) was the cause of AIDS.

Prof Barré-Sinoussi, now the director of the Regulation of Retroviral Infections Division (Unité de Régulation des Infections Rétrovirales) at the Institut Pasteur in Paris, recounts making the discovery that would alter the course of modern medical science.

It was nearing springtime, about a year after her research on the virus began, when she finally managed to isolate the HIV virus and made a link between HIV and the AIDS disease that resulted from it.

“I didn’t know myself about this emerging disease before. I didn’t know that the people who were dying were young, and that they were dying in terrible conditions. It was something really frightening, to tell you the truth,” the 65-year-old virologist shares with this writer at an interview held in Kuala Lumpur.

She was here recently to consolidate the list of events that will take place at the upcoming 7th International Aids Society (IAS) conference.

She recalls the fracas that quickly ensued her discovery of the HIV virus, which revealed an urgent need for diagnostic tests to assist in controlling the spread of the disease. “The feeling right after we discovered the virus was: “Let’s rush! We knew it was an emergency and when you are in an emergency like that, you don’t have time to think,” she says.

Their early findings showed that the virus was transmitted by blood and through the sexual route, as well as from mother-to-child. But there was still a lot of work to be done, in terms of characterisation and identifying the biological traits of the virus, as it was new, so nothing was known, she points out.

It wasn’t until the advent of 1985 when Prof Barré-Sinoussi and her team began to realise that Africa was already strongly affected by the disease. “It was only then that we started to realise that this was something truly frightening for everyone,” she says.

Prof Barré-Sinoussi started her own laboratory at the Pasteur Institute in 1988, an endeavour that would become a lifelong passion for the professor.

Among her more recent research contributions include studies on the various aspects of the adaptive immune response to viral infection, factors involved in mother-to-child transmission of HIV, and characteristics that allow a small percentage of HIV-positive individuals, known as “elite suppressors or controllers”, to limit HIV replication without antiretroviral drugs.

The virologist has also co-authored over 240 scientific publications, participated in over 250 international conferences, and has trained many young researchers. At the international level, Prof Barré-Sinoussi has been a consultant to WHO and UNAIDS-HIV. Since the 1980s, she has initiated collaborations with several developing countries.

In 2008, she was awarded the Nobel Prize in Physiology or Medicine, together with her former mentor, Montagnier, for their discovery of HIV.

The following year, she wrote an open letter to Pope Benedit XVI in protest over his statements that condoms are at best ineffective in the AIDS crisis. In July 2012, Barré-Sinoussi became president of the IAS.

The professor continues to work towards establishing permanent links between basic research and clinical research, with the aim of achieving concrete improvements in the areas of prevention, clinical care and treatment.

She will chair the upcoming 7th IAS conference, the world’s largest open scientific conference on HIV/AIDS, in Kuala Lumpur. The conference, which will be hosted in Asia for the first time, will take place from June 30 to July 3.

The IAS conference represents a worldwide platform for the examination of the latest developments in HIV-related research and is expected to attract some 5,000 scientists, clinicians, public health experts and community leaders from around the world.

This year’s installment will focus on the HIV epidemic in Malaysia, as well as the Asian region, providing local stakeholders the opportunity to discuss all the latest progress in the field, as well as challenges that are specific to Malaysia itself.

According to the United Nations in a Reuters report, “an end of the worldwide epidemic is in sight, mainly due to better access to drugs that can both treat and prevent the incurable HIV virus that causes the disease.”

Prof Barré-Sinoussi is optimistic of the possibility. “In principle, we know from scientific evidence that if we are successful in the universal access to treatment that we have today, then we know that we should be able to end the AIDS epidemic by 2050,” she says.

However, Prof Barré-Sinoussi is cautious: “The word ‘cure’ means a total clearance of the virus, or to totally eliminate the virus from the body. This is going to be very, very difficult; almost an impossible mission.

“This is because the virus can be present in different compartments of the body – in the blood, in different tissues, in the brain. As such, it is very difficult for drugs to reach all the cells that can carry this latent virus.”

She elaborates: “The problem now is, if you stop treatment, the cells will be activated. When that happens, the virus multiplies again and will spread into other cells.

“Hence, if a patient stops treatment and starts again, they will likely risk the emergence of resistance to treatment, and the patient will be required to change the combination of treatment.

“At present, we have some evidence that says that we should be able to develop what we call a ‘functional cure’ in the future. This means that you don’t eliminate the virus totally, but you have a permanent contour of the virus, even when the patient stops the treatment.

“With a permanent contour, the patient will remain with a low level of the virus, even without treatment and he or she will not transmit to others.”

But such treatment may yet be elusive to the masses, she says. “It can only be possible if everyone who is infected by HIV is on treatment. Is that feasible? We have to ask ourselves – how are we going to reach everyone?

“Of course, we are all fighting and will continue fighting for access to antiretroviral treatment for people all over the world. This will get us as close as possible to the goal of endng AIDS.”

Prof Barré-Sinoussi has taken to heart the ideals of the institute’s founder, French chemist and microbiologist Louis Pasteur, since the beginning of her career. Pasteur himself is remembered for his breakthroughs in the causes and prevention of diseases.

“His idea, really, was that there are no frontiers in science. Science is there for the benefit of humankind and it is exactly what we are doing in the field of HIV/AIDS, and in the field of other human diseases. We should continue pushing boundaries in the spirit of Pasteur.

“My dream is certainly to make sure that everyone is on treatment, whether it is novel treatment or the current treatment that we have today.

“I dream that people living with HIV have sufficient care and treatment and that there will be no more mother-to-child transmissions.

“If I can leave this world and know that there is a cure or vaccine, I will be relieved. But for now, it is the simple goal of eliminating mother-to-child transmission that I hope to achieve. Because for me, mother-to-child transmission is just not unacceptable.”

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The history of AIDS
Antiretroviral treatment

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