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Anthony Fauci: “I’m a hero, so I don’t do this. I do it because I need it.”

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While waiting for the HIV vaccine, injectable PrEP is the most promising research direction, Anthony Fauci told aidsmap.com.

“The big question is how I keep going,” Dr. Anthony Fauci said yesterday at a meeting of global health journalists. “Since 20 years, I haven’t had a day off.th Last January, the need to deal with the COVID epidemic is an anesthetic for fatigue. “

Forch, the director of the National Institute of Allergy and Infectious Diseases since 1984 and the headline for most of last year, spoke ahead of a group of health reporters around the world. HIV Research (R4P) Conference for Prevention.. Originally scheduled for November last year in Cape Town, it is now virtually done, in the last week of January and the first week of February.

Fauci entitled “Eradication of AIDS: Maintaining Progress from the COVID-19 Epidemic” in his speech. He started by using simple global numbers to explain the difference between the two epidemics. In the 40 years of the HIV epidemic, 76 million people have been infected. In the year of COVID-19, more people (91 million people) were infected. However, about 2% of patients with COVID-19 died, while 43% of HIV patients died primarily from HIV-related illnesses.

Glossary

Immunogenicity

A substance that can produce a reaction from the immune system.

protein

Substances that form the structure of most cells and enzymes.

Monoclonal antibody

Monoclonal antibodies are antibodies made by the same immune cell, all of which are clones of a unique parent cell. Some of them affect the immune system.

Ribonucleic acid (RNA)

A chemical structure that carries genetic instructions for protein synthesis. DNA is the main genetic material of cells, while RNA is the genetic material of some viruses such as HIV.

Immune system

The body’s mechanism for fighting infections and eradicating dysfunctional cells.

Forch said he did not believe that HIV infection itself would hospitalize people and increase their chances of dying from COVID-19.He said he considered the incidence of severe COVID infections to be high. Found in some studies of people with HIV It was caused by the age profile of the population (more than half of people living with HIV in the United States are now over 50 years old) and the fact that people living with HIV are more likely to have comorbidities.

He also acknowledged that socio-economic factors, including ethnicity, had a strong influence on whether people infected with COVID were ultimately hospitalized. Latino / Latin Americans and Native Americans were more likely to be hospitalized than any other population, with hospitalization rates of 671 and 660 per 100,000 population, respectively. The hospitalization rate for African Americans is currently 598 per 100,000. In contrast, non-Hispanic Caucasian and Asian hospitalization rates were approximately 200 per 100,000.

I asked Fauci: HIV is still with us when the COVID epidemic recedes, assuming the vaccination program works. What direction of HIV research needs to be addressed most urgently as COVID becomes a lower priority?

Forch said he felt there were two of the most promising research programs to significantly reduce or end the HIV epidemic. The first is an injectable formulation of antiretroviral drugs.We already Cabotegravir and rilpivirine It can be injected every 2 months for treatment and already HPTN 083 And HPTN 084 Studies using Cabotegravir preparations as PrEP. Research is being conducted on the use of a drug called islatravir. Monthly pill Or as Implants inserted every year..And recently the drug was announced Lena Capavill It is introduced into preventive studies as a subcutaneous injection twice a year.

The second promising program is monoclonal antibodies, which are somewhere between drugs and vaccines. These twice-yearly infusions can also be used as an HIV treatment... However, returning to COVID, he said that a single monoclonal antibody may promote viral resistance over drugs because it tends to neutralize a fairly narrow variety of viral genotypes. .. Therefore, they had to be used in a wide range of effective combinations.

Fauci described these as “relatively easy” solutions to HIV. According to him, a true HIV vaccine would be more difficult, referring to the “disappointment” of. Travel study..

“Vaccines generally mimic the body’s natural immune response to the virus and usually eliminate the virus,” he said. “This is why I knew-it wasn’t expected. I knew that In –98%, the immune system will sooner or later clear the virus, so a COVID vaccine can be developed. But that’s not the case with HIV. Therefore, vaccines need to elicit a better immune response than nature, which is difficult to do. “”

Asked if the rapid development of the COVID vaccine provided lessons for HIV vaccine development, he said research on the COVID vaccine did not start from scratch in 2019. “The official name of the COVID-19 virus is SARS-COV-2. This was 10 years ago. We faced SARS-COV-1. They are similar viruses and the COVID virus is It was based on a 10-year research platform. “

He said this was one answer he gave to vaccine skeptics who believed that the COVID vaccine could not be developed without omissions.

He commented that HIV vaccine research has “absolutely” enabled the development of COVID vaccines. The pre-fusion conformation of the HIV envelope protein See the figure in this article – Much more immunogenic than other conformations and could be stabilized by inserting extra links into the numerator. Forch, a colleague of the National Institutes of Health, Dr. Bernie Graham, The same technique could be used to stabilize the SARS-COV-2 peplomer Earlier last year, it triggered an “exquisite immunogenic” response that served as the basis for the COVID vaccine.

The Pfizer and Moderna vaccines are based on the long-awaited technology of messenger RNA. “We hope that what is happening and this will be fed back to the development of the HIV vaccine,” Fauci said.surely Moderna published early results from animal studies At the AIDS 2020 conference in July using this technology.

“Another way I deal with vaccine skepticism is to keep telling people that it’s not the federal government or pharmaceutical companies that are driving the research,” he said. It’s science itself. 30,000 to 40,000 people participated in the COVID vaccine trial, the results being validated by independent data and safety oversight committees and approved by a transparent and independent drug regulator that exists solely to evaluate science. I will.

“If you get rid of politics and continue to explain science, I think those who have doubts will ultimately understand that both vaccines and public health measures work, mostly because they don’t work. Is to call a fool. “

Asked about the personal differences that the COVID epidemic has made in his life, Fauci made the above comment on the need for work to spur his energy.

“One of the things I do every day has nothing to do with science. I go for a run,” said Forch, who turned 80 on Christmas Eve.

“The only difference now is that I used to do it during the lunch break, but now I have to do it in the evening because the day was occupied by the Zoom session and the call to the White House.” He hopes it will intensify in the coming months.

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