Dr Rajat Goyal: ‘To end AIDS, we need a vaccine’

Today’s guest blogger is Dr. Rajat Goyal, India Country Director of the International AIDS Vaccine Initiative. 

When I was a young medical student in Mumbai, telling a patient they had HIV was like reading them a death sentence: they had little hope of long and healthy life. Today, that is thankfully no longer the case.

One reason for this change is the development of antiretroviral medicines, which have revolutionized the way we think about HIV/AIDS. Here in India, terrific work by the government and the National AIDS Control Organization to make these drugs available to those who need them has helped cut the number dying from AIDS by approximately one-third.

Other countries have seen a similar story: nearly 10 million people now have access to antiretroviral drugs globally, and AIDS-related deaths have fallen sharply.

Providing Care and Support for Women Living with HIVWomen in India learn how to deal with living with HIV in this Global Fund program. Photo credit: The Global Fund. 

Perhaps understandably, this good news has led to speculation that AIDS may soon be a thing of the past. In Delhi, my morning newspapers have been filled with exciting stories about patients who seem to have been “cured” of HIV after experimental treatment, and claims that we are approaching “the end of AIDS.”

However, as a doctor working on AIDS research, it is clear to me that such claims are very premature. Unfortunately, the pandemic is far from over. In India, around 140,000 people still die from AIDS every year, and over 110,000 are newly infected. It is still an enormous challenge to get drugs to everyone who needs them, and women and girls remain particularly vulnerable to HIV infection.With around 2 million Indians living with HIV, the financial costs are also formidable.

In other countries, the challenges are even more acute. More than 6,000 people worldwide are newly infected with HIV every day, and the pandemic is still spreading faster than the drugs to treat and prevent it: more people are newly infected each year than gain access to treatment.

In this context, it is clear that to “end AIDS” we must not only provide more of what works, but also develop a vaccine.

Of course, developing vaccines is not easy, and HIV/AIDS is a particularly difficult target. At the laboratory in New Delhi where the International AIDS Vaccine Initiative works with the Translational Health Science and Technology Institute, scientists are racing to keep up with a virus which mutates so quickly that it dodges almost every weapon the immune system throws at it.

However, recent years have seen some great progress. In 2009, a study in Thailand found that a candidate vaccine could reduce the risk of HIV infection by around 30%, proving that an HIV vaccine is possible.

Another exciting area is what we call ‘broadly neutralising antibodies’; proteins which can block the virus from infecting cells and occur naturally in a small number percentage of people. Our team is working to identify these antibodies and design vaccines which encourage the immune system to produce them.

The work has also generated  short-term benefits, such as building laboratories and conducting studies which help improve health services where they are needed most. In Maharashtra – an Indian state with relatively high HIV prevalence – household surveys help track the virus and map the groups most at risk of infection, while local communities benefit from services including free HIV testing, counselling and referrals for treatment.

Despite recent progress, there’s still a lot to do. The scientific challenges we face are significant, and cuts in funding have hit researchers hard. But after over 25 years of research, the question is no longer ‘if’ we will have an effective vaccine but ‘when’. With dedication and perseverance, we can develop a vaccine, and make the end of AIDS a reality.