By Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson
In 1983, I began my career in healthcare as a trainee in a hospital in Kinshasa in the Democratic Republic of the Congo, while I was still a medical student. This was when we first started seeing a large number of patients with HIV disease, and we only just learned that the cause of disease was viral. It was the beginning of the epidemic.
A massive number of people in Africa became infected — by 1986 as many as 2 million people had HIV. Patients were dying, children were being left without families, and there was a significant impact on overall life expectancy with a decrease of 20 years in several countries on the southern part of the African continent.
HIV today is in many ways a different disease than it was then. When it emerged we didn’t know much about it. Today, we have characterized the disease and understand what its mechanisms are, how it is transmitted, and what to do and not to do for treatment. We have gone from treating HIV patients with up to two dozen pills a day to being able to treat them with one pill a day. People are living long healthy lives, thanks to the development of more than 20 drugs and combination therapies, in first, second and third line. One of the most satisfying achievements in my life was participating in the HIV treatment R&D process and leading the development of new therapies that have changed the course of the history of the disease.
The HIV research community is making significant progress, but all of us acknowledge that while the outcome of HIV treatment is good, it still requires patients taking medication lifelong, every day, without missing one pill. Preventing HIV altogether would be far better. Over 2 million people are newly infected with HIV every year, and that number has not changed since 2010. A recent issue of The Lancet HIV focuses on the work that still needs to be done to improve HIV prevention efforts, with its editors emphasizing that, “…although the gains in treatment are most definitely to be applauded, prevention must not get left behind.”
HIV prevention has to be holistic. Over the last 10 years, Johnson & Johnson has developed three transformational HIV medicines. We also have a unique collaboration with the International Partnership for Microbicides (IPM) for the development of a vaginal ring that delivers dapivirine, a molecule from our research labs, as a microbicide, which could help prevent the sexual transmission of HIV.
The development of a safe and effective vaccine is the “holy grail” and would represent a historic scientific achievement that could change the future of populations worldwide. However, HIV attacks the immune system itself, so stimulating the immune system with a vaccine to mount a protective response is very challenging. We believe it can be done with approaches that are both scientifically creative and highly collaborative.
Our next generation approach for the development of a potential HIV vaccine includes strong collaborations with multiple partners. Results from pre-clinical studies in non-human primates show that a heterologous prime-boost HIV-1 vaccine regimen, in development at Janssen, might provide for an efficacious vaccination strategy for preventing HIV-1 infection in humans. And based on these pre-clinical data, the vaccine regimen including Ad26 based vectors delivering mosaic HIV-1 antigens is now being evaluated in an ongoing Phase 1/2a international clinical study in 400 healthy volunteers.
United with our partners, our ultimate goal is to help ensure that every baby is born HIV-free, adolescents and adults stay HIV-free, and people living with HIV have access to the medicines they need. The global community made previously unimaginable progress in the 30 years since the emergence of the disease. Continued focus on the development of an HIV vaccine can make HIV history. To learn more about Johnson & Johnson’s efforts in HIV prevention, read more here.