Interview with Luc Montagnier

AIDS: building up immunities

For the past ten years, Luc Montagnier, winner of the 2008 Nobel Prize for Medicine, has been insisting that efforts to stem the AIDS epidemic must involve a combination of prevention and a therapeutic vaccine. At first, his call for a vaccine fell on deaf ears. But, today, he has high hopes that soon a therapeutic vaccine will enable a body infected with HIV to build its own defences.

Luc Montagnier was interviewed by Jasmina Šopova.

The World Foundation for AIDS Research and Prevention that you set up under the aegis of UNESCO is already 15 years old. What are its aims and what results has it produced?

The Foundation aims to promote AIDS research and prevention, especially in developing countries, which are the most affected by this disease. It sets up pilot centres in these countries to develop a triple strategy, combining prevention, education and research.

In 1996 we set up a research centre in Côte d’Ivoire with, of course, the agreement and aid of the Ivorian government at the time. We have since received the support of all the country’s successive governments. The Centre is in the capital, Abidjan, but there are branches in other Ivorian towns.

We started by setting up a laboratory dedicated to isolating the virus. Today the Centre has a new building for diagnosis and the treatment of outpatients. It also has a lecture room for education and prevention. Here, we train trainers to raise awareness in the local population on AIDS prevention in the workplace. For example, most of what, in Africa, are called “the uniformed corps” (the military, police, fire fighters, customs, rangers, etc) have sent delegations for training in our Centre.

You recently opened a Centre in Cameroon, too. But, according to UNAIDS, it is mostly in Southern Africa that the epidemic is reaching disastrous proportions.

Although the figures for West Africa are less alarming than those for Southern Africa, they are still much higher than anything we are seeing in industrialised countries. The rate of infection in Côte d’Ivoire is currently running at about 5.7%. This is not negligible.

We looked into the possibility of opening a centre in South Africa a few years ago. But at that time the authorities there were not convinced that the virus that we had isolated was the cause of AIDS, and so they did not offer their support. In the Congo, Gabon and Tanzania, the Heads of state were interested, but we came up against the question of funding.

It should be pointed out that the Foundation can only act if States support it, by providing land or funding. The Centre in Cameroon is funded by the government and aid from developed countries, such as Italy. I should also say that the government of Cameroon is making remarkable efforts in terms of youth education. I was surprised to visit schools where children aged 8 to 10 knew all about AIDS.

The Abidjan Centre operates partially with its own funds. A large number of patients use it – those who can afford it, pay, of course. Those who cannot, do not pay. Treatment is often provided free, thanks to government policy and aid from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

Have you run into any cultural obstacles?

Africa has its specific problems. It is therefore extremely important to take the cultural context into account. Certain local practices facilitate transmission of the virus, such as ritual scarring of newborns, or childbirth without sterile instruments.

Often, women come into the maternity clinic in good health and leave HIV-positive, because of the re-use of non-sterile medical equipment. The main reason is a lack of resources, but there is also a lack of information. Babies are sometimes infected by the milk of wet-nurses who take care of them while their mothers are working.

At the same time, many people do not want to be tested for HIV, for fear of stigmatisation. Our role is to convince them to be tested so that they can then be treated. But when they are treated, some abandon the therapy for financial reasons as soon as they start to feel better. The result is that they fall ill again.

Do you work with traditional healers?

We could definitely envisage working with traditional practitioners. But it is not easy to regulate their products, since their composition is a secret, passed down from generation to generation. And, because they cannot be patented, their products are of no interest to the pharmaceutical industry.

In our Abidjan Centre we tested a product from Japan, based on fermented papaya extract. The Japanese hold the secret of how it is made, but here is an example of a well-defined product, according to pharmaceutical criteria, and which has been subject to controlled clinical trials. Each batch is identical, which is not always the case with plant extracts.

Trials showed that this product is not a replacement for triple therapy, of course, but it did enhance its beneficial effects on the patients’ immune system. We have carried out a second clinical trial and are waiting for the results.

We are also testing other immunostimulants. If the therapeutic vaccine that we are currently working on is to succeed, the patient’s immune system has to be restored. Triple therapy alone is not enough.

You think that AIDS will be eradicated through a therapeutic vaccine. You already spoke about this in 2000 in UNESCO Sources magazine. What is the status of research today?

The concept can already be traced back ten years. In the beginning, the idea of a therapeutic vaccine got a very poor reception from French and international funding bodies. The idea was not appealing, because there were hopes for a preventive vaccine and it was thought a cure would be found.

Much has changed since then. We now know that triple therapy is not a cure and that lifelong treatment provokes toxic effects, leading to other illnesses that are often fatal.

Today the therapeutic vaccine project is mature and on a better course, because it will receive private funding.

Do you think that the Nobel Prize will help you to find other sources of funding?

To be short and precise, I hope so!

What are the advantages of a therapeutic vaccine?

Nature provides us with examples of people who are HIV carriers, but are not ill with AIDS. We are looking for a therapeutic vaccine that will increase the immunity of someone who is infected, enabling his or her body to defend itself. Someone infected will therefore be able to live with HIV without developing the illness.

It should be remembered that treatment for one person costs $12,000 a year, and it may go on for 20 or 30 years. A vaccine, on the other hand, requires just three injections: two successive shots and a booster later on. It’s standard. No matter how much it costs, it will be 20 - 50 times cheaper than triple therapy.

When will we see a cure for AIDS?

Curing people and getting rid of the epidemic are two different things. Curing is indeed our immediate objective, and this will have a significant effect on the epidemic. When people know that they can be cured, they will more readily come forward for testing, those cured will no longer pass on the virus, and so on.

But we cannot expect that we will miraculously find a cure overnight. We should not count on a preventive vaccine in the immediate future. Personally, I do not believe in a preventive vaccine for AIDS. Clinical trials have shown that groups who were vaccinated were more likely to become infected than those who were not, because they believed they were protected by the vaccine, which was not the case.

AIDS could be eradicated by a combination of treatments that involves cure, information and education, especially targeted at young people in schools. Even if we find a preventive vaccine, we must still continue to educate people to behave responsibly to prevent the spread of HIV.

• 25-11-2008