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 Interview with
Dr. David Ho
CEO of the Aaron Diamond AIDS Research Center, Professor at Rockefeller University Medical School and Head of the China AIDS Initiative
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CBS CARES: Why do you think you can be successful in stemming the AIDS crisis in China when it has been so difficult to do so in various other countries?
DR. HO: Well, in some ways, China is still a developing country, but it is not a typical developing country. In China, there are maybe 300-400 million people who are better off and have more resources than others in the country. If we could convince that portion to take stock of this situation, then the haves in China could help the have-nots. The other factor is the Chinese way of doing things. If you could convince the Chinese government that this is serious and could threaten its stability or economic future then it can mobilize very effectively as we witnessed with SARS in 2003. If you look at the initial course of SARS, China made a terrible mistake. That was an embarrassment in front of the rest of the world. But once it reversed course and took the right path, it did so highly effectively and shocked the international community in how quickly it brought SARS under control. In that respect, we think that we need to do our advocacy work. If the Chinese government could take on more and more of the responsibility, it will make a major contribution to curtailing the spread of this virus in the country.
CBS CARES: Is there health insurance in China?
DR. HO: For a limited number of people living in the richer, coastal region, there is the beginning of the private health insurance. But, the Chinese epidemic is largely a rural one, mainly affecting the poor who do not have access to health care or health insurance.
CBS CARES: Do you believe that generic drugs should be used in China?
DR. HO: Well, they are being used. China already makes four generic drugs. Unfortunately, these do not make a good combination. You would have to add a drug like 3TC from America to boost the power and effectiveness of drug regimens.
Until recently, China was using strictly generics that are made according to World Trade Organization rules so they're not in violation of any intellectual property laws. They are gearing up to make more, but they're waiting for some of the patents to expire and for the government to work out deals with multi-national pharmaceutical companies.
CBS CARES: One projection is that by 2010 the number of worldwide HIV infections will be 105 million. Five million were infected last year alone…is it true that last year marked the largest number of infections in any year since the start of the AIDS pandemic?
DR. HO: That's right. And some feel that the numbers are more dire than the projected 105 million. India alone could have 25 million infected by 2010 and you have to add the 10 million projected for China…that is, if nothing dramatic is done in these countries.
CBS CARES: Would you also say that the spread of the AIDS pandemic to countries like China, India and Russia increases the threat of AIDS to the global economy?
DR. HO: Yes, I think it is already a burden, but hitting these major countries you mentioned would increase the economic burden a great deal. We all know that China and India are becoming increasingly economically important to the world. China, for example, is a manufacturing juggernaut. So, if the epidemic were to become much more diffuse throughout China and affect, say, the coastal provinces, then it would be an even greater threat.
CBS CARES: Well, if after more than 20 years of the pandemic, AIDS is spreading faster than ever…do you think that the disease is winning this war, so far?
DR. HO: As you know, there's been tremendous scientific progress made on HIV. But the progress has been most meaningful for people living in developed countries, particularly the patients in those countries. If you look at the epidemic curve in Africa or in South Asia, it's as if all the advances have made no difference. I think that, in realizing this inequity, more and more agencies are trying to close the gap and deliver treatment. And, also importantly, there are more prevention efforts in the countries where the virus is spreading most rapidly. I don't think we will change the global pandemic until we begin to address prevention in a very serious way, of course continuing to do so in Africa, but also in these so-called second wave countries like China, India and Russia.
CBS CARES: Can you tell us about the vaccine aspect of your partnership with China?
DR. HO: The vaccine is a much longer-term effort. We made the vaccines here and are doing human testing in New York. At some point, we would like to take it to China and do the subsequent clinical trials there.
CBS CARES: From your experience, do you believe that there will be an effective vaccine and/or cure for HIV in our lifetime? Is that an achievable objective?
DR. HO: I guess if we didn't think that was possible we would not be working in this field. Certainly for a vaccine, if we felt that it was futile, we'd be better off concentrating on another project. It's clear from the animal experiments that it is possible to achieve a reduction of progressive HIV infections using the kind of strategies that we're using.
We're reasonably optimistic that we could get at least a partially effective vaccine. And, if it's not 100 percent effective, we should not make perfection the enemy of the good. If there is anything that would help slow down this epidemic, we should push ahead and others can come along and improve upon the first generation vaccine. On your question about a cure, it's not within reach right now, even though we have very good therapies that control HIV very well and people are living very productive lives in the U.S. and Europe on treatment. But HIV is still not cured ffrom those people. The virus is hiding out in small amounts in certain cells. We have yet to come up with strategies to purge those elements from the infected person.
CBS CARES: Your organization discovered the CCR5 receptor on the CD4 immune cell, which is one of the doors for HIV entry and infection of those CD4 cells, right?
DR. HO: Scientists in our institute discovered it, yes.
CBS CARES: Since the CCR5 receptor is part of the process by which HIV infects cells, does your vaccine research include how that receptor can be genetically adjusted to resist entry by HIV?
DR. HO: Well, that knowledge is very useful, but we're actually not manipulating the CCR5 molecule. We are just manipulating the viral proteins to present those proteins to the immune system. And you can say the CCR5 molecule might be very important in that process. What you're suggesting would be more akin to gene therapy. That is being attempted by some other groups but we're not involved in that directly.
CBS CARES: What do you view as the most promising vaccines candidates that are currently in development?
DR. HO: Well, the ones that are being worked on right now in terms of concrete development of vaccine candidates are all in one way or another very close to the strategies that we're taking. One is to use what's called DNA plasmids or viral vectors. These simply are vehicles to deliver HIV genes safely into humans or into animals. And then once delivered into the host, HIV proteins would be made in the host. Of course, this won't be infectious, but the immune system will see those proteins as if there's HIV infection and therefore begin to mount an immune response. So when the real virus comes in, it could be blocked.
CBS CARES: Would this be an antibody response?
DR. HO: Antibodies, but the tough part is that antibodies do not work very well against HIV. HIV has evolved to have a shield. If you're a believer in Star Wars, HIV has that force that protects it, so the antibodies sort of bounce off the shield. That shield actually consists of certain structural elements like carbohydrates. So it's actually very, very clever how this small virus has evolved to be so challenging for us.
CBS CARES: So these vaccines will really result in a cellular immune response?
DR. HO: Yes, the current approaches rely heavily on the cellular responses. I'm impressed with all these questions…you must be working on the CBS program CSI!
CBS CARES: So you watch CSI?
DR. HO: I do sometimes watch it.
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