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Everybody counts. Today is World AIDS Day, a day highlighting the need for the 36.7 million people worldwide living with HIV. This year’s campaign #LetsEndIt, calls to end the isolation, end the stigma and end the negative impact of HIV. In recognition of this, and the World Health Organization efforts to promote ‘everybody counts’ and the ‘Right to health’, we hear from our ‘HIV Infection and AIDS: Vaccines’ Faculty Members, who discuss the research and advances being made in vaccine development. Antu Dey’s interview is here and we speak with Jim Tartaglia below. 

Jim Tartaglia, Global Vice President for New Vaccine Projects at Sanofi Pasteur, oversees the entire vaccine development pipeline for Sanofi Pasteur. His decades spent on HIV vaccine research gave him the foundations, a broad perspective and the breadth that he needs to fulfil his current position.

In the mid-80s, Jim started out as a research scientist with the New York State Department of Health before joining Virogenetics in 1990 to work on pox viruses, at a time when HIV vaccine development was in its infancy.  

He shares when a vaccine regime was first considered as a preventive strategy for HIV, and emphasizes that science carried out in isolation is not the way to progress. To advance, we need to collaborate, work together globally and with multi-disciplinary teams.

Working on an immunization vehicle

For the last three decades my HIV research has focused on developing highly attenuated and efficacious poxvirus-based vectors as an immunization vehicle for human and veterinary vaccines. Early-on at Virogenetics, my work on attenuation of vaccinia virus led to the generation of NYVAC-HIV vaccine (a highly attenuated strain of the vaccinia virus derived from a plaque-cloned isolate of the Copenhagen vaccine strain) by precise deletion of 18 open reading frames and served as a good candidate for vector vaccines.

Additional research showed the importance of ALVAC-HIV vaccine (ALVAC was used in the 6-year, prime-boost trial conducted in 16,000 volunteers in Thailand and was the first to show any efficacy) and TROVAC vectors for targeted applications as recombinant vaccines in both human and veterinary medicine respectively.

I initiated the ALVAC-HIV development work in 1995 along with the U.S. National Institutes for Health (NIH), with the first set of human trials starting in 1996. Soon thereafter Sanofi Pasteur engaged with the Walter Reed Army Institute for Research (WRAIR) to evaluate ALVAC-based vectors.

You played a key role in the HIV Thai trial that led to the idea that a vaccine regime can reduce the risk of HIV. Please can you tell us a little more about this development?

Based on available scientific data, a decision was made in 1995 to focus on poxvirus-based candidates, specifically ALVAC-HIV.  The RV144 trial was initiated in Oct 2003 by the US Army, partnering with the National Institutes of Health. The study results from RV144 came in September of 2009 and were the first to show any efficacy, albeit modest, that a vaccine regime could possibly prevent HIV.

I’ve always believed that HIV vaccine research has to be a collaborative effort between public and private organizations.  We need to collaborate even more to advance the field.  To this end, I was an important contributor in setting up the Pox-Protein Public-Private Partnership (P5). To be successful in a complex field like HIV vaccine research requires one to have an acute sense of business, science and public- health paradigms.

At Sanofi Pasteur, we’ve always shared reagents to further contribute to the science beyond our direct involvement. Moving forward, we need to continue to work together, sharing risks and rewards. We are now in the process of extending the results of RV144. A phase IIb efficacy study of a similar regimen used in Thailand, with adaptations for the specific clade of HIV circulating in South Africa, was started there last year. Results will not be known for several years.

What is being done to accelerate and transform vaccine development?

The work done so far in the quest for a vaccine to prevent HIV has already better informed other investigative vaccines and facilitated development.  It’s also provided molecular insights into pathogenesis of disease and a better understanding of the human immune response, providing more-informed design and decision making, and a higher probability of success.

We need to have the capability to manage and leverage “big data” to progress science and its impact on society. The current inter-dependence of different fields to address science has brought on a convergence of technologies. We now must work in global, multi-disciplinary teams. The old idea of a scientist working independently is no longer the case. Science cannot be done in isolation.

Today, system immunology and ‘omics’ bring evolving technologies together to further our understanding of the human immune system, enabling more effective means to prevent and treat disease. With the use of immune markers, we hope to reach proof of concept earlier.

This year’s World AIDS day motto is ‘You helped fight HIV, now let’s end it’. The UK has seen the first significant reductions in HIV diagnoses, but there are still more than 100,000 people living with HIV in the UK alone, of who, many still face discrimination. What needs to be done to overcome transmission and improve mental health for people living with HIV?

Like any infectious disease, we need to prevent the initial infection to stop the viscous cycle of transmission. Herd immunity is the basis of any prophylactic vaccine’s success when it comes to infectious disease and HIV is not any different; it’s just been a harder one to develop a vaccine against, but I believe we are getting much closer.

In the meantime, as far as those living with HIV, which there are many today due to the success rate of treatment, we need to remember that disease does not discriminate, including HIV. We cannot judge people based on a virus that’s infected them. Hopefully as treatment continues to advance, and those living with HIV continue to be productive members of society, the stigma of the last century will be forgotten.

The ultimate answer to HIV is prevention, and the tool still needed is a globally-relevant, HIV preventive vaccine, although getting there will be an incremental process, as all science is.