01 December 2017

Features of national AIDS

Professor: a Soviet person could not have AIDS, it spoiled the whole picture

On the first of December, the World Day against Acquired Immunodeficiency Syndrome – HIV/AIDS (World AIDS Day) is celebrated. This year in Russia has begun the next stage of work on an HIV vaccine. The RIA Novosti correspondent talked about the victories and defeats in the fight against this virus with the head of the research laboratory "Molecular Virology and Oncology" of Peter the Great St. Petersburg Polytechnic University (SPbPU), Professor Andrey Kozlov, who at one time registered the first case of HIV and the first death from AIDS in the USSR.

The word "vaccine" is missing from the AIDS strategy in Of Russia

– The other day you started working on a combined HIV vaccine. Tell us more about it.

– This is a scientific project on the interaction of Russian and Chinese scientists who decided to combine their achievements into one. We are talking about creating a combined vaccine: it will include a Russian component (DNA vaccine) and a Chinese component – protein (booster).

The interest of the PRC in this work is a hint to our state. All over the world, work on vaccines is funded very intensively, including in China, and only in This is not happening in Russia.

– Why do you think?

– Mythology is strong in Russia. At first there was a myth that we don't have sex, there are no drugs, which means that there is no AIDS and there can't be, and there is no immunodeficiency virus. But we found both. Then there were other myths – for example, that we do not know how to diagnose AIDS, do not identify drug addicts, and so on. Recently, the myth has spread that it is impossible to create a vaccine against HIV. In my opinion, this is a consequence of the struggle for money: "Since it is impossible to create a vaccine, why finance the work on its creation, it is better to spend money on the purchase of imported medicines."

The word "vaccine" is missing from the State strategy to combat AIDS in Of Russia. The Stone Age! I have met twice in the Public Chamber on this occasion. Everyone recognizes that the topic is important and necessary. The Ministry of Health is not against it, but the Ministry of Health does not have money for a vaccine. The Ministry of Education and Science is also not against it, but the Ministry of Education and Science cannot conduct clinical trials. It turns out that seven nannies have a child without an eye. The interdepartmental program hung somewhere between the departments.

Now look at what is happening in the world. In 1997, we started a program to combat HIV at the same time as Americans. Russian research was conducted in three cities for 15 years. Since 1997, two stages of the program have been implemented: the first stage cost the state two billion rubles, the second – one billion rubles. As a result, three domestic candidate vaccines have passed the first phase of clinical trials, and one (DNA vaccine) - the second phase of clinical trials.

Meanwhile, Americans have been allocating $500-600 million annually to work on creating a vaccine since 1997. This is only public money. Plus money allocated by the Bill Gates Foundation. In total, it turns out about one billion dollars. Over 20 years, they have spent $20 billion on developing a vaccine and tested many more candidate vaccines against HIV.

Most experts are inclined to believe that the American HIV vaccine will be created between 2026 and 2030.

– What specific successes have scientists achieved during this time and for this money?

– Work on a vaccine in all countries is like a "Lunar project". What have we achieved on the moon, besides flying there? But the "Lunar Project" has greatly advanced technology in all areas.

The situation is similar with the HIV vaccine. Firstly, there are a number of chronic and viral diseases, including cancer, against which there are still no vaccines. Work on the AIDS vaccine stimulated the development of anti-cancer vaccines. There are outstanding successes in this direction, and cancer developments have already overtaken AIDS.

Secondly, one of the candidate American HIV vaccines showed activity during trials in Thailand. Let it be small, but active: 60 percent protection in the first year and 30 percent in the second. Now these data are being checked and rechecked. There are definitely achievements, both in the work on a preventive vaccine and in the work on a therapeutic vaccine.

The early phase was skipped by all countries except Russia

– How did the preventive vaccine give such an indicator? How is its activity checked?

– This is checked on cohorts. Cohorts are large groups of people, tracked over time, in which there is a high incidence of HIV. In the control group, 100 people should be infected for statistics. Usually, these tests are carried out by a double-blind method (placebo-controlled): no one knows in which group the vaccine is used, and in which group the placebo is used. If 100 people are infected in the control group and 50 in the vaccinated group, this means that the activity of the vaccine is 50 percent.

At one time, in the St. Petersburg cohort, the infection rate among drug addicts was from 10 to 20 percent. Thus, to conduct clinical trials of a preventive vaccine, we needed a group of one thousand to two thousand people.

– That is, you gathered two thousand drug addicts and examined them for HIV infection. What did you find out?

– We have proved that in The uniqueness of the HIV situation in Russia lies in the fact that more than 90 percent of cases of infection are caused by HIV–1 strains belonging to the Eastern European variety of subtype A.

During the 15 years of the epidemic development, it was found that the level of genetic diversity of subtype A strains in Russia remains very low. Simply put, we have our own subtype of HIV, which is characterized by a high degree of uniformity. Americans have a very heterogeneous virus, it is either difficult or impossible to create a vaccine against it. It's easier for us in this sense.

In addition, we have discovered in drug addicts the phenomenon of the so-called genetic "bottleneck" in the transmission of the virus. It was a phenomenal discovery. It meant that the infection is carried out by almost one viral particle, which is proved by the method of deep sequencing of a new generation. Science magazine devoted an editorial to this Russian discovery.

– It was in your laboratory in 1987 in Leningrad that a case of HIV was first registered in The Soviet Union. Were you under pressure then?

– We organized the first health screening in the USSR in Leningrad and recorded the first case of HIV infection as part of this screening. Moreover, the first death from AIDS in our country was registered, and we were strongly advised not to do this. A Soviet person could not have AIDS, much less die from it. It spoiled the whole picture. Believe me, it was uncomfortable for us to work in such conditions.

When we started screening, we were caught in violation of human rights. Then we started working on a vaccine, and we were accused of spending public money on impossible things.

Science is always ahead of the curve, sometimes doing things that people don't understand, and often getting into an environment of misunderstanding and pressure. I assure you, it was even more difficult for Copernicus than for us. Nevertheless, we all now live in a heliocentric system. So it is with vaccines against AIDS and other infectious diseases.

The Paradoxes of Russian AIDS

– What phases of development have this disease had since the very moment when you registered the first death from AIDS in the USSR?

– All AIDS epidemics are characterized by the following phases: early phase, concentrated and generalized. All countries of the world, except Russia, missed the early phase. We were able to study this phase more or less.

The early phase – from 1987 (from the beginning of screening) to 1996 – we had practically no HIV-infected people: less than a thousand HIV-positive people in all of Russia. There were two paradoxes in the early phase. The first paradox was that tens of thousands of African students from endemic regions of Africa, where the epidemic originated, studied in our country. They had a great sexual life, but for some reason we didn't have a heterosexual epidemic. I still can't find an explanation for this phenomenon. 

The second paradox: in our country, drug addicts were not infected with HIV, which by that time began to appear. We assumed that the dirty drug – heroin, which they prepared in terrible home conditions – contained a virus inhibitor. And so it turned out.

When pure drugs from Afghanistan appeared after 1996, the traffic of white powder opened through Russia, it was then that everyone was over–infected - and the second concentrated phase of the epidemic among drug addicts began.

– What phase of the epidemic are we in now? 

– In the bad phase – in the third, generalization phase. We won the first stage of the fight, which was associated with the early phase: we delayed the epidemic as much as possible. When the first girl died of AIDS, a special meeting of the Politburo was held, AIDS Centers and hundreds of laboratories were established throughout the country.

Thanks to screening, we have "closed" blood banks from HIV. In addition, work was carried out with HIV-positive people, and they largely stopped infecting other people. Low numbers have been held for 10 years.

The second phase, when drug addicts became infected, we completely lost: we could not contain AIDS in their environment in a concentrated form. The infection began to be transmitted heterosexually to the general population.

Now almost half of all cases are transmitted by heterosexual means. The epidemic has begun to generalize.

– Do you agree with the official statistics, according to which in Russia from 700 thousand to one million HIV-positive? How do you assess the effectiveness of treatment of these people?

– Chemical therapy is a scientific feat and an absolute triumph of science. Antiretroviral drugs are quite effective, but they are lifelong drugs, their cost is constantly increasing. What does it mean to take medicine all your life? These are serious side effects. Medicines do not cure, but turn the disease into a chronicle.

No one knows exactly how much in Russia HIV-positive: 700 thousand, a million or more… The important thing is that in any case it is a lot. All these people should be provided with free treatment. We are currently treating a quarter of this number – and it costs about 20 billion rubles. It turns out that we need 80 billion rubles. Where will we get this money? We need a vaccine.

You can't sit and wait for the Americans to do it. The Americans have their own virus, we have our own. It is not a fact that their vaccine will work against all varieties of the virus. I don't believe it. 

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