Francoise Barre-Sinoussi - President Elect, International AIDS Society HARDtalk

risen to 61 people. Time for HARDtalk. Could we soon

see a cure for her HIV/AIDS? Francoise Barre-Sinoussi thinks so.

She is a Nobel Prize winner who helped to identify the virus 30

years ago. She says the need to pour money into fighting the

disease is as great as ever. Already, nearly 30 million have

died from it. By the time I have finished this introduction another

three people will have contracted it. Another two will have died. But

with budgets being cut, can we afford more expensive research?

Francoise Barre-Sinoussi, welcome to HARDtalk.

Thank you. It seems extraordinary that a short

time ago scientists were barely talking about a cure for AIDS, and

now you are saying that it is a potential reality for the near

future. How did the change come about?

First of all, it is not new to talk about a cure. But with any great

certainty it is. Of course it has been researched

already. A bunch of scientists were working already on that aspect

without any results. The reason why we're talking about a cure today is

because we have some evidence that it might be possible. First of all

we have what we call the Berlin patient, the patient that is HIV

positive, had a bone transplant because he developed leukaemia, and

it turned out that after two bone marrow transplants, we can say that

we cannot detect the virus in his body anymore. It is the proof of a

concept somehow that we did not have before. There is also this

group of individuals that are HIV positive for many years, some of

them 15 years. It is a small group, less than 1%. They have never

received any treatment and they are doing well. They control their

virus. I want to talk to you more about

the science behind it, how it might work, in a moment. But first of all,

you have described the search for a cure as a necessity. Because of

your concerns about the long-term efficacy of treatment. Why are you

saying that now more than ever before it is necessary to find a

cure? Why is it so necessary? First of all I will not say that it

is because of a lack of long-term efficacy of the treatment, because

the treatment we have today it is a good treatment. We know that we can

reduce the mortality by 90%. It is not a bad treatment at all. The

reason why we are pushing for a cure is because we know that it is

a lifelong treatment. We know that it is of course very difficult for

access, universal access to treatment, for everybody. We know

as well that there is a small proportion of patients that on

long-term treatment are developing complications. That means that we

need to have new tools for the future. We have wonderful treatment

that is efficient today. Presumably there is also a danger

with the treatment, because it is something that people have to take

every single day for the rest of their lives. If they cannot do that

you could end up with a resistant strain of the virus.

That is right. We know that adherence to the treatment is very

important otherwise they can develop resistance to treatment,

and they can also transmit a resistant form of the virus to

others. Of course this is a problem. But mostly, the current treatment

is very efficient. Is there a danger if you find a

cure, though, that it will mean people will be less concerned about

preventing getting the disease in the first place?

If we have new tools for a cure... Maybe we should define 'cure' first.

'Cure' means that you totally eliminate the virus from the body.

But there is another definition of cure. It is what we call functional

cure. That means that you control persistently the infection without

total elimination of the virus on the body.

Forgive me for interrupting. The effects could mean that people will

revert to the sort of behaviour that help spread the disease. Using

condoms for example. That was difficult to get people to use them.

If people can control by themselves their infec their infecey

will not transmit to others. We know that already. We know that

with the actual treatment. We know that treatment is also prevention.

We know that if we are efficiently controlling the virus in the body,

then the virus is not transmitted to others. Imagine the future.

Imagine that we have a treatment that the patient can stop, but they

keep their virus under control. They will not transmit to others

anymore. Understood, but do you not fear

that people will become less responsible about the way in which

they have sexual relations, the way in which they use intravenous

drugs? I mean, of course there is always

education, counselling, and that will be a continuing effort. It is

part of the prevention. It is part of education. That should remain

forever. Let me ask you to explain a little

bit, take me through gently if you will, but a little bit about the

science of how this cure might work. From what I understand it involves

interfering with some protein in the cell which is an entry point

for the virus. Is that correct? It is one target. It is not the

only one. Of course, the fact that the current treatment we have

cannot be stopped and is lifelong is because the virus remains

dormant in some cells of the immune system. What you are mentioning is

one of the approaches, to reactivate the dormant virus from

these cells. We have already some data indicating that probably will

not be sufficient. You also have to probably stimulate the immune

that reactivates the virus from the dormant cells with a kind of

vaccination. And you need to eliminate immediately the

reactivated cells. Isn't this a form of gene therapy?

If it is, I realise I am probably using a shorthand, but if it is, I

am just wondering how far can that be scaled up? Gene therapy is

labour intensive. It is expensive. It is difficult to see it being

rolled out across the world. Gene therapy is one approach, but

not the only one. For example, there is also the approaches that

are already ongoing, like using drugs targeting some of the enzymes

that explain why the virus remains dormant. That is not gene therapy

at all. It is just using a drug. Do you fear that in this search, in

the push to find a cure, that you could end up diverting money away

from more established ways of tackling the disease?

Certainly that is not the goal at all.

I realise that. But is that not a concern given that money is tight?

People know that there is a certain amount of money for AIDS research.

It could leave other people exposed. The idea is to try to have

investment of both. We as a group of researchers are trying to

accelerate research on HIV cure. Investment for current access to

care, of prevention and treatment should continue. Research for a

vaccine should continue. Indeed, a vaccine might be part of the cure.

So we need to continue to invest in both. The treatment that we have

today is short, middle term approach to try to control the

infection. We are thinking about the future.

What do you say to those people who say, as it is, AIDS research gets

basically too much money? There is too much money for this disease

when there are other diseases out there not being dealt with.

HIV is a virus that attacks the cells of the immune system. It is

also a tool to understand better the immune system and how the

immune system functions. Why in that case would somebody

like an AIDS expert, somebody like Dr Malcolm Potts from the

University of California, say that if we look at data objectively we

are spending too much on AIDS? I know this kind of statement from

several scientists in the world that are not generally involved in

HIV research. Well, he is.

I think myself that you have to consider what is the progress that

has been made that may be useful for other diseases.

But it is not just about high-end science that you are talking about.

It is about aid budgets generally. If we think about one-fifth of all

global deaths from diarrhoea occur in just three African countries,

but they have relatively low HIV prevalence.

Yet they get very scant attention from those preventable deaths, but

a huge amount of money for their AIDS-related programmes. You can

understand why some people say that the AIDS programme completely

distorts medical budgets. It is a question of budget for

global health. That is not related to science. If you look at the

effort that has been made in several countries for HIV/AIDS, we

are starting to see the impact on the global health in those

countries, not only in the HIV/AIDS field. I agree there is not enough

data. I used to say to people, we must have more data and evidence

showing that investment that has been made for different diseases

and the impact on other diseases. My point is that there is finite

amount of money and even more money is set to go. It could end up that

money is going into AIDS research and away from other programmes

which could possibly prevent more deaths.

I do not believe so myself because when we look at the research, one

characteristic of HIV is that the virus can induce chronic

inflammation. And we are trying to understand chronic inflammation,

which is one characteristic of cancer and cardiovascular disease

and ageing disease. If we understand better the mechanism of

chronic inflammation, we can help other diseases as well. Instead of

opposing HIV research or funding I think it will be more intelligent

to work together. Especially at a time of economic crisis.

We have talked about money. Let's also talk about how people see the

disease. You became very upset when the Pope, on his visit to Africa in

2009, said that AIDS was a tragedy that could not be overcome by money

or the distribution of condoms, which even aggravated the problem.

You wrote an open letter to the Pope and he seemed to change his

stance slightly after that. To allow for the use of condoms in

How do you respond to the apparent shifting? Some changes in his

position. Was it an improvement? Certainly not because he mentioned

specific circumstances. The original statement was indicating

that condoms were not fully demonstrated as efficient.

principle point was that the problem about the prevalence of

condoms is that it makes, in his words, sexuality banal. If you look

at the reality. Myself, I have met nuns and priests working in Africa

and Asia. They are facing the reality. They are distributing

condoms themselves. The evidence is that you are struggling to win the

argument. If we look at a couple of states in the US Utah and Wisconsin

- they are considering bringing in a new law which will teach

abstinence as the contraceptive to children. Why are you losing the

argument in places like that? counselling that is done before and

after testing for HIV. All the means you mention - abstinence, or

at least education, are part of the counselling given. If people do not

have sex they will not contract HIV. But, given that you think it is not

the most efficient or the only route, why are you losing the

argument in places like Utah and Wisconsin? I am not losing the

argument. I say that prevention is a combination of different

approaches. Changing behaviour is part of prevention. Condoms and

circumcision and treatment are all parts of prevention. Already we

know that the combination of tools for prevention are needed. I am not

pushing only the condom. Let me take you into an area where you are

pushing something quite dramatic - intravenous drug use. You have

called for a complete decriminalisation of drug use.

That flies in the face of most legislation in the world. There are

few politicians who would endorse such a move. I am a scientist so I

always take that into consideration. The French government is opposed to

the creation of supervised injection centres for drug addicts.

Why do you think it would help to have it decriminalised? Research

shows that repressive measures do not improve access to care,

prevention and treatment for IV drug users. Repressive measures are

negative. As a scientist I base my opinion on that. Even if it flies

in the face of political orthodoxy, you are willing to go there? It is

interesting to hear you talk in this way because you do not just

see yourself as a scientist, but also an activist. You use terms

which are not scientific, not cool and calculating. You talk about

your upset, your fury about your fight for funding, for example. Why

in these terms? Because, as a scientist, like many others, I have

worked to contribute to the development of truth for the

benefit of humanity. Globally. And why I say sometimes that I am

furious is because we have to live together today. And when I see that

the tools are not available for everyone, that makes me furious.

Because they are diverted to the banking crisis? To what? Because of

discrimination and stigmatisation of some of the population. That is

opposing access to testing and counselling and care and treatment.

Because of the restricted funding that limits the access to treatment

for everyone. We have seen during the last year that there is all the

international affect we have been able to go from 50,000 people on

treatment to 7 million people on treatment. How concerned are you

that even if the fight against Aids is won that the next pandemic is

just around the corner? Especially with the increasing

interconnectedness of the world? That can happen but I think we

should keep in mind the experience of HIV/Aids. Think of it as a kind

of model. In the early 80s we used to say it was a crisis. An

emergency. People were dying. has been an emergency for 30 years,

and one which you have been involved in. When will we see a

cure? I cannot answer this question if I am honest. We do not know.