They are both about the same. Only cancer is more complicated because it includes many different diseases. With AIDS you can pour yourself into one, single, unifying cause – HIV – so there is a chance of really doing something about it in total. Whereas in cancer you have to treat each type of cancer as a singular different disease, in which you are looking for some common pathways in which we are beginning to learn.
So, I would say they are different kind of challenges. Parenthetically, I still do work in cancer for example we are very much interested in the types of cancer that occur with an increased incidence in people that are HIV infected.
When you reflect on the 30 years since AIDS – do you find that there were both challenging and hopeful times?
Certainly there are at least a few periods in my career where I felt like that. The first took place before AIDS when we were trying to prove that humans could be infected by retroviruses and it was a decade before we proved the point with the only known leukemia causing virus, HTLV-1 which can also cause a fatal neurologic disease, HTLV associated myelopathy/tropical spastic paraparesis (HAM/TSP). In fact HTLV-1 is very important in Latin American countries and Japan for the greater frequency. But trying to prove that even retroviruses existed before the discovery of HTLV-1 and HTLV-2 was long, difficult and sometimes frustrating.
With HIV, the frustration came in the 1982 and early 1983 period which included trying to establish whether the retrovirus now known as HIV was the cause of AIDS. With some early hints of detections in 1982 we obtained much more evidence in 1983 but we couldn’t get the linkage of this particular virus to be the cause of AIDS.
This took time and technological advances in our laboratory and even then to have sufficient information to convince the world was not easy. Science does not move unless you have verification – that is confirmation by other laboratories.
In that regard, when we developed the blood test we know this would facilitate linkage of HIV as the causative agent of AIDS because it was the kind of technique that could be easily reproduced around the world. However this linkage did not happen overnight. It did not happen with one virus detection. It happened by gradual accumulation of data over a period of a year and a half.
Were there any moments during your AIDS research when you thought, “we’ve solved the problem?”
No doubt there was a key point in time in our work. That was the period of the fall of 1983 when we learned how to grow some of the strains of HIV in a cell culture system continuously and permanently.
We knew immediately with this success we would be able to produce very large quantities of HIV which was not previously possible with large quantities of HIV we could have sufficient amount for world blood testing (which soon did occur). And with these large amounts we could get genetic information on the virus – that is we could understand its various genes and its proteins.
What was it like being a scientist suddenly thrust into the world of money and politics?
Like most young doctors, I simply went to school. I really hardly ever had a job other than school. I went to college, then medical school, and then I was trained to become an internal medical person with an interest in hematology and cancer.
After this long training period I came to the National Cancer Institute where I worked both on the wards and ultimately where I worked fulltime in laboratory research. You can imagine my world experiences were little. I was fortunate that my father did a lot for me, so I didn’t have to worry about anything.
Then all of a sudden you are researching a disease in which you are meeting the patients – that was novel and I was not prepared for that. Second, you are meeting activists. Thirdly, you are meeting politicians. Fourthly, you are sometimes meeting famous people. Fifthly, your opinion is being asked of you about things you have no idea. You are not an expert on everything, but rather a few things, and yet you are asked about things on which you have no idea! Also you are drawn into the world of lawyers over patent problems. Can’t you imagine that this would have been a little scary?
Do you believe there is complacency around HIV infection?
Yes, there is more complacency today – it’s obvious, and it’s understandable because we have such good therapy, and the production of generic drugs in Brazil, China and India contributed to making therapy less expensive and available also to people in developing Countries.
Having said that we have to emphasize that HIV/AIDS is not a disease which is cured. People obviously live better and longer but they still have virus and that still leads to a slightly shorter lifespan, an increase in cancers as well as cardiovascular disease.
So the problem is far from over even in the people who are getting adequately treated. Of course a lot of people aren’t adequately treated. I heard an estimate that in the U.S. with all our care, only about 20% of people are adherent to drugs and getting the right therapy.
Why do young people need to be concerned about HIV infection today?
Well, of course the antiretroviral drugs do not solve the issue but make it much better. We are still in danger of getting infected.
If you were infected, you would have to take drugs for the rest of your life at this stage. Who likes to do that? Some of the drugs will have long-term side effects, although not very bad, so far. And as I mentioned, already there is an increase in incidences of cancer, cardiovascular disease and a shortened lifespan. So for all those reasons and more, you should not want to get infected and you should still be cautious.
Did AIDS change people’s attitudes towards minority issues?
Yes I do believe there is a change of attitude. I think one of the good things that came out of this horrible story of AIDS is that there is a greater understanding of differences in people’s sexuality. There is also a greater understanding of differences of people of North and South, East and West, and a greater cooperation between us. Additionally people are paying more attention to women’s rights.
You believe in a “functional” cure, but not a virological cure. What are the differences between the two?
I don’t believe there are any promising strategies for a total virological cure. Except in theory with some kinds of gene therapy which I do not see on the horizon for the world – maybe for a few select people but even then I think it is not really at all certain.
So I would not waste resources going in that direction. It’s difficult because you have cells that are what we call latently infected, impossible to find, that are long-lived and periodically apparently release virus. It seems that no matter how hard people try, those cells are still there, and will always be there. I don’t think we are going to get rid of every last such cell. Nor do I think it is necessary.
Functional cure would mean that an HIV infected person could keep the virus suppressed with evidence that the person wouldn’t ever need to take the drugs anymore. I think that is reasonable and will likely happen within the next 5 to 10 years.
The scientific community has been saying that the cure for AIDS will happen by 2020. It is feasible in your opinion, on a global level?
Yes I think it is feasible if we are talking about a functional cure. If we are talking about a virological cure I think that is fanciful. If a scientist says that they believe in a total virological cure by 2020 I would say that the scientist doesn’t know what he or she is talking about.
What were your contributions versus the French group? What do you think about the 2008 Nobel decision?
We opened the field by finding the first retrovirus of man, HTLV-1, the second retrovirus of man, HTLV-2 and we established the link of HIV to AIDS as the causative agent. Dr. Montagnier’s paper was certainly the first to report a virus different from our previous retroviruses (the HTLV’s) we discovered.
Dr. Montagnier’s paper precedes ours in the actual first detection of the virus that is later proven to be the AIDS virus. This is what we did in early 1984 – we had 48 different isolates of HIV from 48 different patients and we were able to demonstrate HIV was the cause of AIDS. Additionally, we developed the blood test, which gave a great deal of additional information showing HIV was the cause.
Dr. Montagnier and I have published together and have little if any disagreements. For example, we published together in Nature, which was Montagnier and Gallo, we published together in the New England Journal of Medicine, more recently which was Gallo and Montagnier on the discovery of HIV as the cause of AIDS.
The Nobel committee is composed of 4 or 5 Swedish gentlemen – it’s their decision. Was I disappointed? Yes, and very surprised. But I don’t complain – many countries around the world have honored me with many awards both with and without my colleague Dr. Montagnier.
Some of these – which are more than my fair share in a lifetime – include Germany’s Paul Ehrlich Prize which is their highest prize, Japan’s highest scientific and technological prize, and the Prince Asturia Spanish Prize, and the American Lasker Award, which I received twice. I’ve also received Israel’s top prize, the Dan David Prize and Canada’s Gairdner Award.
What is your current ambition?
My current leadership ambition is to leave a legacy of an exceptionally good Institute – the Institute of Human Virology (IHV) at the University of Maryland School of Medicine – which I co-founded. My second ambition is to leave the legacy of the Global Virus Network (GVN), which I co-founded only three years ago.
As for my laboratory ambition, it is to gain a greater understanding of infectious causes of cancer. I have a few of them so far. My colleagues and I have discovered a total of five different viruses. I would like to find more associations of infections and demonstrate that they are they are involved in the cause of human malignancies.
I have a goal with AIDS as well. I would like to see a functional cure and I would like the IHV to contribute to that. More than that, I hope our vaccine candidate will be important in moving the field towards the ultimate truly successful preventive vaccine against HIV. We hope our candidate vaccine will start clinical trials at the end of the year or beginning of next year.
Interview with Dr Robert C. Gallo on the 30-Year Anniversary since announcing HIV as the cause of AIDS. April 21, 2014 (by Franco M. Buonaguro)
For more information on IHV please visit www.ihv.org and on GVN please visit www.gvn.org