Fequently Asked Questions

HIV/AIDS Quiz

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How close are scientists to developing a vaccine for HIV?
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Kent Weinhold, Ph.D.
Professor of Surgery & Immunology, Duke University
Directs the Central Laboratory for International HIV Vaccine Trials Network

An efficacious vaccine for HIV, that is one that would prevent HIV infection, has been the goal that we've all had for now almost 25 years since the first case of HIV was first documented.  We're getting closer, but we kind of view this process as akin to a jigsaw puzzle, and there are some major pieces of that puzzle that are still missing that will be required for us to develop a completely effective vaccine.  We've made tremendous strides in developing strategies.  Now we need to get a little bit smarter in the areas of how to elicit long-lasting immunity and how to deliver that immune response to the mucosal surface because, again, most of the new cases of HIV infection are sexually transmitted, heterosexually transmitted, and we want to, again, have a vaccine, or we believe that a vaccine that is going to be efficacious is going to need to be a vaccine that delivers the right immune response to the right area, and that is the mucosal surface.  We're not quite there yet, but I think we're getting closer.  I'm an optimist, and I think from an optimistic point of view I would hope that within the next ten to 15 years we would solve some of those major missing pieces of the puzzle and would be able to put together a vaccine that would prevent infection – that's the ideal goal.  If we can't, if we fail in preventing infection, I think the second choice would be to have a vaccine that, although not preventing infection, could control viral replication and to suppress virus replication to a low enough level such that we would prevent any disease progression.  In other words, we would control virus replication such that the disease does not progress and it would become a chronic disease, but even more importantly we would control the level of viremia such that there would be less of a likelihood that the infected patient would be able to transmit to a new individual, and so, again, converting HIV into more or less a chronic disease under the guise of a vaccine-induced immune response.  So I think we want to at least reach that point, but I think ideally we'd like to reach a point where we really do provide sterilizing immunity, and this type of requirement is something that really has not been met heretofore with other vaccines that have been routinely used in man.  So we're asking more of this vaccine than we've asked of any previously licensed vaccine for treatment of human disease.

Will there ever be a cure for HIV or AIDS?
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Kent Weinhold, Ph.D.
Professor of Surgery & Immunology, Duke University
Directs the Central Laboratory for International HIV Vaccine Trials Network

An absolute cure for AIDS, at least the way I interpret it, would be our capacity to take an infected individual and eliminate every last semblance of the virus, and as you know HIV has the unique capacity to integrate in the host cell genome, and so it becomes part of the host cell genome, and that makes it increasingly difficult because it can hide in the host cell and hide and not express itself.  So if we think about cure from the standpoint of eliminating every last bit, every last remnant of virus, I'm somewhat less optimistic.  I think cure from the standpoint, can we prevent disease progression, can we again control virus replication to the point where disease does not progress and transmission can't occur from person to person, although not a cure, I think it's a very reasonable and realistic goal.  I think we have to, as we're designing strategies for treatment, we have to keep in mind that we have to make rational treatment strategies available to the third world, particularly to Sub-Saharan Africa and other hot spots throughout the world, and that means that we can't have complicated treatment strategies.  That has confounded dissemination of those strategies to other parts of the world, so we're getting closer to that.  We're getting closer to strategies where a single pill once a day or several times a day is now within our grasp, and so if we can take that and translate it into delivery into non-Western countries, I think we've gone a long way.  So even if we can't cure – that is, eliminate the last semblance of virus – again, this is somewhat akin to herpes virus infections.  The virus is always there, there are flare-ups, etc, but the virus can largely be controlled through therapy.  I think a similar type of thing is a realistic goal for HIV.

Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine

I am very optimistic that there will be a cure for AIDS.  We're not there yet, and I think we're still looking at something that is probably a good decade or more away, but we have hope.  We're making new strides with treatments.  We have approaches now that are getting folks very early in infection and trying to get rid of the cells that hold on to HIV for a very long time in infected individuals.  Then the vaccine programs are really beginning to ramp up in a new and novel way, and I'm optimistic that within ten to 20 years, we can see some real significant breakthroughs.

David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine

I do.  And I think from my previous answers you can kind of tell that I'm fairly optimistic about this disease and this infection.  I think there will be a cure for HIV.  I think there's important work going on here and at Duke and other places that will contribute to that.  I think that what we'll see is over time a better understanding of how to eliminate the virus from the places where it hides.  Once we're able to do that, coupled with the powerful medicines we have now to control the amount of virus that's replicating inside the body, I think we'll have a really good handle on how to control this, maybe even eradicate it.  Another important aspect of this is we're recruiting your own immune system to fight the virus in a way that it naturally doesn't, or augmenting or enhancing the way your body fights the virus.  If we can bring all these different factors into play and, again, kind of heap these on top of one another to fight the virus, I think we might find that we're going to find people who are able to eliminate the virus from their body.  Now I can't tell you when this is going to happen.  If you asked me in 1993, would I expect there to be a revolution in HIV drugs which occurred two years later, no one could have predicted that, and it's just been amazing what we've seen over the last ten years as far as HIV therapeutics.  I think the same thing might happen, and I'm hopeful it will happen, as far as a cure.

I've heard that HIV and AIDS aren't that big a deal now that there are so many medicines.  Is that true?
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David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine

I'd be really cautious about taking any sort of viewpoint like that.  This is still not a pleasant infection to have, and anyone who is on HIV medicines who's doing well will tell you it's work.  It's not easy.  So there really isn't that kind of safety net.  Things can also happen.  Medicines don't always work the way we want them to, and there are side effects to the medicines.  Coming to the doctor is a hassle.  Getting your blood drawn is a hassle.  And, again, we don't know what the long-term picture is.  I'm optimistic, but we know that some people just don't do well.  You don't want to be one of those people.  The best way to prevent that from happening is not to get HIV at all.  So I really think we have to place a lot of emphasis individually on our keeping each other safe.  We have to all be deputized in the fight against HIV.  We have to spread the word.  We have to spread the word in our Churches, our Mosques, our Synagogues, our community groups, our schools, in our families.  This is something people don't want to talk about at the dinner table, but it's so much more important than many of the things we do talk about at the dinner table.  This is a pandemic.  That means it's an epidemic times ten, and it's spreading throughout the world.  Millions of people are dying, and millions of people have already died from this infection.  And this is very, very preventable.  We could shut down the HIV pandemic right now if we could have people take safer measures and not spread the virus to anyone else, and I think it's really incumbent on each of us to really work hard to make sure personally we don't get infected, and if we are infected to not spread this virus to anybody else.

How significant an issue is HIV/AIDS in North Carolina?
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Kent Weinhold, Ph.D.
Professor of Surgery & Immunology, Duke University
Directs the Central Laboratory for International HIV Vaccine Trials Network

The issue of AIDS in North Carolina, I think, is extremely significant.  And I think the reason that people have, that this has long gone as ignored, is we've now convinced people that this is a global problem, and we focus on outbreaks where the seroincidence and seroprevalence of HIV infection are just off scale.  But I think in doing so we've done our own citizenship in North Carolina a disservice in that now people see this as a global problem and they don't think that the problem exists locally.  But this is a sexually transmitted disease, and we're seeing increases.  We continue to see increases in North Carolina in other sexually transmitted diseases – gonorrhea, syphilis, chlamydia, etc. – and co-transmission of these agents along with HIV is a tremendous problem.  So the new infections with HIV, that problem has not gone away and, in fact, it tends to be pushed aside as we start to focus on more global issues of HIV, but it remains a highly significant problem in North Carolina.

Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine

HIV is a very significant issue in North Carolina.  North Carolina has some of the highest number of cases of HIV in the entire United States.  We were number seven last year in number of reported cases of new HIV infection, and our numbers have remained pretty consistent over the last several years, around 1700 new cases a year.  So though we're now in our third decade of the HIV epidemic, North Carolina continues to see new cases, and we're one of the higher places in the country in terms of states with new HIV infection.

David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine

HIV is a significant issue for the planet, to begin with.  I feel that 50, 100 years from now when people look back at our time, this time we're living in right now, there'll be lots of things they'll be talking about, but the HIV pandemic will be at the foremost.  I think history books will look at this as the era of AIDS.  When you look at this as a planet issue and not just as a North Carolina or an Orange County or a Chapel Hill issue, people can understand the magnitude of this is so far beyond almost anything else we can imagine.  Many of the things that make headlines today pale in comparison to the devastation being wrought by HIV today – not ten years ago, not five years ago, we're talking about right now how many people - women, men, and children, communities, villages, cities, countries - are being devastated by this infection, by this one virus.  Here in North Carolina, we're not immune to that.  Thousands of people are infected with HIV every year, and we see plenty of people come into our clinics newly diagnosed every week in our clinic here, and Duke has the same problem.  So we continue to see this spread.  We see this spread among different segments of our population.  No one is immune from this infection.  So I think it's a significant problem.  We certainly spend a lot of our resources and our time, and we lose plenty of tax dollars to people who are laid up because of their infection.  So I think we have to pay it particular attention.  We know that in the United States right now, the south is the number one area of the region, the number one region of the country, where people are acquiring and living with HIV infection.  So it's not the northeast, it's not the northwest, it's not any other part of the country; the south is where HIV is hitting hardest in the United States.  And that's where we are.  So I think we have to take a really hard look and think about why are we seeing so much HIV and how we can do something to prevent HIV from becoming an even greater problem in North Carolina as it is today.

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