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Q&A: Assessing ‘spin-off’ impact of HIV/AIDS research
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Almost 40 years of HIV/AIDS research has led to substantial advances across many medical fields, according to an editorial published in The Journal of Infectious Diseases.
Anthony S. Fauci, MD, director of the National Institutes of Allergy and Infectious Diseases (NIAID) and Tara A. Schwetz, PhD, branch manager in the strategic planning and evaluation branch at NIAID, said HIV/AIDS research has not only advanced the understanding of viral biology, pathogenesis and life-saving antiretroviral therapies, but also has had led to “collateral broader scientific research progress.”
As the largest funder of HIV/AIDS research, the NIH has contributed nearly $69 billion to research efforts between 1982 and 2018, Fauci and Schwetz wrote. Since the first reported cases of AIDS in the United States 37 years ago, the support HIV research has received has led to “spin-off” discoveries about the immune system, cancer, hepatitis and heart disease, they said.
Infectious Disease News spoke with Michael S. Saag, MD, director of the University of Alabama at Birmingham’s Center for AIDS Research, about the exhaustive research that has gone into HIV/AIDS, the impact it has had on other medical fields and where future research may lead. – by Marley Ghizzone
How has HIV/AIDS research contributed to advances outside of the field?
HIV/AIDS research has contributed in many ways. The most obvious and impactful contribution is in the study of hepatitis C virus (HCV). The approach to developing small molecules that attach to viral enzyme targets was perfected with HIV medications and directly applied to HCV with the development of direct acting antiviral agents (DAAs), which have revolutionized the treatment of HCV. The DAA drugs lead to cure of HCV infection in over 98% of people taking the medications. This saves lives but also creates the opportunity for the elimination of HCV from the planet, at least theoretically.
Why does HIV/AIDS research overlap with other conditions and diseases?
When we assess the bigger picture, the use of drugs to treat infectious disease still represents less than 100 years of medical history. We are celebrating the 90th year since the discovery of penicillin this year. The heyday of antibacterial agents ran from 1945 to 1990 (penicillins to quinolones). Antifungal therapy was predominant from 1972 to 2005 (amphotericin to eichinocandins). This is not to say that drug discovery for antibacterial and antifungal agents has stopped or is no longer needed ... it’s just easier to conceptualize revolutionary discoveries in time periods.
We are now in the era of antiviral drug development (1981 to today; acyclovir to sofosbuvir). The antiretroviral agents of HIV catalyzed drug discovery for other viral diseases through the use of crystal structures of viral enzyme products, allowing the identification of targets for drug inhibition. This technology is being applied to many other viral diseases in addition to HCV, including other flavivirus diseases and Ebola. The search for a cure for HIV is opening doors for the treatment and potential cure of other viral infections that establish latency, such as hepatitis B virus.
What other avenues of HIV/AIDS research are being explored?
As mentioned earlier, the approach to a cure for HIV is leading to insights related to the establishment of viral latency and approaches to elimination of latent infection by viruses that can open doors to the treatment of other latent viral infections.
In addition, on the behavioral and community science front, HIV research is leading the way in the study of barriers to testing, linkage to care, retention in care and long-term suppression of viral replication that leads to reduction in transmission. Interventions to eliminate barriers to each of these steps can be applied to many other chronic disease states, such as diabetes and hypertension. Finally, the study of HIV related aging is generating collaborations that help to address aging in the general population.
Where does research need to focus?
Research needs to focus on a cure, vaccines, prevention and eliminating barriers to care and aging.
What future impact do you think HIV/AIDS research will have?
By studying the natural history of HIV among treated patients and contrasting outcomes, scientists will uncover basic biologic principles of the metabolism, physiology and biochemisty of aging ... which it is hoped will lead to interventions that will help both HIV- and non-HIV-infected individuals slow the aging process and improve well-being and function into the later years of life.
References:
Schwetz T, et al. J Infect Dis. 2018;doi:10.1093/infdis/jiy441.
Disclosures: Saag reports receiving research support and acting as a scientific advisor to Bristol-Myers Squibb, Gilead, Merck and ViiV.