In the first of a series of articles called Meet the researcher, highlighting the research at St George’s, University of London, Dr Qinxue Hu, Senior Lecturer in the Institute for Infection & Immunity, discusses his work and marks World AIDS Day which happens each year on December 1.

hiv and aids

calendar-icon 11 December 2017


How is the fight against HIV infection going?

The number of new HIV infections has decreased. This can be attributed to the increasing awareness of HIV prevention in the world, extensive preventive work, more effective detection methods and therapeutic drugs, as well as the increasing number of people receiving treatment with antiviral drugs.

To reach the goal of definitively stopping and reversing the spread of HIV and accelerating the epidemic’s decline, ambitious objectives have been set by UNAIDS for 2020: diagnose 90% of those infected, treat 90% of those diagnosed and achieve stable undetectable HIV plasma viral loads in 90% of those treated.

People in the West mostly have treatment options so why are these not appearing as effective in places like Africa?

This is likely due to many patients in places like Africa not taking any treatment at all because of poverty, lack of awareness, and lack of accessible health care resources. In the West, the widespread use of antiretroviral drugs accelerates the emergence of drug-resistant strains but in places like Africa people are more sensitive to the antiretroviral drugs. The prevalence of antiretroviral drugs drives the evolvement of HIV more quickly.

There are reports of both a vaccine and patients with inbuilt resistance to the HIV virus. How optimistic are you that we will see the end of the HIV epidemic in the next 10 years?

Combined with other prevention methods, a vaccine could dramatically lower the number of new infections and prevent disease associated with AIDS. A 31% protective effect in the landmark RV144 trail, which was publicly released in 2009, suggests the possible success of a HIV vaccine. For those infected, predictions indicate that if the 90-90-90 objectives are achieved by 2020, the trend of the HIV/AIDS epidemic could be reversed. A 70% reduction is estimated in the incidence rate of new infections between 2010 and 2030, as well as a 65% reduction in mortality, which could be less than 500,000 deaths annually in 2030.

How do your research and the research at St George’s fit into the battle against HIV?

A number of HIV research projects are being conducted by St George’s researchers. These include:

-       developing new strategies capable of enhancing anti-HIV immune responses at mucosal surfaces, like the vagina or rectum, where the virus enters the body.

-       enhancing the body’s own ability to fight the infection with the use of gene transfer employing safe adeno-associated viral vectors to persistently deliver inhibitors to prevent HIV infection and dissemination.

-       using genetically-modified plants to produce large amounts of neutralising antibodies that can be used as topical microbicides to block HIV transmission, making prevention more affordable to developing countries.

-       investigating personalised medicine technologies for HIV.

-       the development of therapeutic HIV vaccines.

How long have you been researching in this area and how optimistic are you about a cure or vaccine yourself?

I have been working on HIV since 1997 when I investigated how the virus enters human cells at the University of Louisville in USA. I joined St George’s in 2000 working on the mechanisms of HIV infection at mucosal surfaces like the vagina and rectum, and my group is trying to develop novel approaches to prevent these processes.

Although the development of a vaccine against HIV has been complicated by a number of factors, there are reasons to be hopeful that an effective HIV vaccine is possible.

The moderately efficacious RV144 vaccine trial proved a good opportunity to understand the immunity required to protect against HIV infection. In addition, growing evidence indicates that broadly neutralising antibodies do emerge naturally in a significant fraction of infected subjects, albeit after years of infection. As for HIV therapy, although current antiretroviral drugs are unable to eradicate the virus, it is believed that by combining interventions aiming to stimulate the immune response and prevent new rounds of viral infection and spreading may achieve a functional cure.

HIV is notoriously difficult to treat as it mutates, do scientists such as yourself understand why it is so adaptable and are there other diseases which are as difficult

In the case of HIV and other retroviruses, mutations are primarily attributed to error-prone reverse transcription during viral replication. There is an indication that there is more variation in one HIV-infected individual than in an entire pandemic population of flu viruses. That is staggering and indicative of the challenges HIV researchers face. In addition, the HIV genome within the human host is capable of profound and durable variability. A latently infected cell can be super-infected by multiple HIV variants, enabling the emergence of genetic recombinant forms of the virus. In modeling studies, multiple escape forms can appear simultaneously and persist to confound typical host development of effective immune responses against HIV.

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