IHV In the News

20 years later, Gallo looks at AIDS, future

Baltimore Sun
November 12, 2004
By Jonathan Bor
Sun Staff

Q: Twenty years ago, did you ever imagine that the disease would become the pandemic it has: 20 million lives claimed, nearly 40 million infected today across the world? A: In some respects yes, and in other respects no. By the time we submitted our papers [reporting the discovery] in March of 1984 for publication, we were beginning to collaborate with people who were applying our newly developed blood tests. So we know it was becoming really widespread. A dramatic example of that occurred when a post-doc of ours from Tokyo obtained serum from hemophiliacs receiving Factor 8, a blood-derived product. In March or April of 1984, nobody was positive.

LEARN MORE ABOUT... Robert C. Gallo: Biography of IHV's Founder and Director

Then, a few months later, after using blood products from the U.S. and Europe, we found 20 percent of the hemophiliacs were positive. So we had no doubt this was going to become a global epidemic.

What we didn't expect is the uniformity - that without today's therapy it was almost completely fatal. Very few microbes kill virtually everybody they infect.

Q: On a similar note, did you imagine that you and others in the forefront of AIDS research would still be pursuing a cure and a vaccine 20 years later?

A: No, I did not. I thought I'd be back full time with cancer research. But also, I certainly thought that this was a virus that wouldn't go away. To make an analogy, what's worse - the plague or this? It depends on how you look at the world. The plague really rushes through like a tornado, killing things in its path, but then rather quickly disappears. But we knew the nature of retroviruses [a class of viruses that includes HIV and hepatitis B and C] - they don't go away.

So I knew that if we didn't do anything about it that this wasn't going to go away. But I expected that medical science would solve it with a preventive vaccine by now. I didn't expect any cure therapeutically. Remember, we didn't have any chemical therapy against any other viruses except very toxic drugs that weren't very effective.

But the surprise has been the wonderful therapies that became available. ... So we thought there would be little therapy but success with a protective vaccine, and it turned out to be quite the opposite. On that, our instincts were completely wrong, and the vast majority of people thought exactly the same thing.

Q: One obstacle to creating an AIDS vaccine is that the virus mutates rapidly, making it a moving target. At your institute, Timothy Fouts and Anthony DeVico have developed a vaccine designed to elicit antibodies against a variety of AIDS strains. How far along is this vaccine and how close to human trials?

A: We are in the final stages of discussions with a major pharmaceutical company. I would expect everything by the end of the year to be done. We'll do research. The company would fund the research and make the product. It won't be more than one to two years for the first phase [of clinical trials, which measure safety]. ... But I don't know all the social, political and even scientific [hurdles], like production, production costs, working out this agreement and that agreement. It takes so frustratingly long.

The real point of this, it's a big mistake to go into vaccine research when you're in middle age - better when you're in your 20s. Then, one of the problems is that a young person can't get funded for research like this.

Q: Do you think you'll have a chance to see a vaccine?

A: [Laughing]. I don't know. I've got to stay healthy.

Q: Since creating the Institute of Human Virology eight years ago, has your work taken any surprising turns? Has the focus turned out differently than you imagined?

A: In one substantive way: the international angle, the amount of global public health. If you told me 10 years ago that I'd be in Russia related to public health issues and in China to form collaborations with the Chinese CDC, to get them to commit to the problem with maximum scientific force, and [that our group would be] greatly involved in Africa, I would have been surprised.

Q: When you first came to Baltimore, you said that the city - with one of the highest HIV infection rates in the country - offered a perfect laboratory for research into treatments and vaccines. Has this proved to be the case?

A: Absolutely, a very strong yes. On a very practical level, we have the patient population to be able to help and be able to collectively learn more.

We've seen the evolution of drug resistance, the problem of compliance, the need for basic research. We see firsthand the extent of [drug] toxicity and what areas we need to work on. And we've learned, for instance, that we can give a rest period for people on the drugs. We've had the privilege of seeing people who didn't get any care before get care now. We've seen people who were undertreated and at death's door ... come back. All of this is more than we could have hoped for.

Q: The drug cocktails that have been in use for several years have enabled people to live much longer, free of serious symptoms. Yet they are not a cure. Do you see anything on the horizon that would wipe out the virus, never to return?

A: No, I do not. That gets into the extraordinary molecular biology [of HIV infection]. You've got to sense out every cell that harbors silent genes of the virus. There are many cells, though their percentages are small, that harbor these genes in a silent form. Having drugs that can find the genes and kill these cells is out of our reach in the foreseeable future.

[Gallo, however, said he is excited about a new class of experimental drugs, called entry inhibitors, that block the virus from getting inside cells of the immune system]. They are a wonderful new class. Remember, we have increasing resistance to the currently used drugs. Until "pharma" comes up with more and more drugs, resistance is going to be a problem.

Q: This year, a consortium led by the institute and Catholic Relief Services was awarded a $335 million federal grant to deliver AIDS drugs in Africa and the Caribbean through faith-based groups there. The grant covers five years. Why the emphasis on religious groups?

A: It's important for the general reader to know that it's not limited to faith-based groups, but we are working with faith-based groups that have been on the ground in Africa for a long time and have a track record of being trusted and doing good work. ... [These] groups are better than governments in getting to the people. People would have to say, 'Why not?' "

Q: Does this mean the programs will be promoting abstinence-only prevention, which would mean not talking about the role of condoms in blocking prevention?

A: The answer to that is a simple no. Look, Uganda is the most successful program in the world. Yes, condoms are available, but they also preached monogamy - not to cheat on your partners. Clearly, they make part of the program that sex can transmit the virus and that an important part of prevention is staying with your partner.

Q: Since coming to Baltimore, have there been any major pleasant surprises or disappointments?

A: On the pleasant side, there is no question that Baltimore is a wonderful city... much more than I would have anticipated. People are original, interesting. I have season tickets for the opera; now I have season tickets for the Ravens. We're a city of characters. The University of Maryland also has many major pluses.

On disappointments, yes, but I won't comment.

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