Editor’s note: This is part two of our interview with Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergies and Infectious Diseases. Click here to read part one.
Unlike the coronavirus, the AIDS virus’s ability to permanently infect the human body has made it more difficult to develop an AIDS vaccine, and research into a cure for HIV/AIDS is continuing to advance but remains in its “very early days,” according to Carl W. Dieffenbach, who has served for the past 25 years as director of the National Institutes of Health’s Division of AIDS.
But in an interview with the Washington Blade, Dieffenbach, who holds a doctorate degree in biophysics, said the already highly effective antiretroviral drug treatment for HIV is continuing to advance to a point where the current one pill per day regimen may soon be replaced by a single injection that will make HIV undetectable in the body and untransmitable for six months and possibly a full year.
He said the single injection advance would be applicable for both people who are HIV positive as well as for those who are HIV negative and are taking the current one pill per day prevention medication known as PrEP.
“One of the things I am most happy with is the whole U equals U movement – that undetectable equals untransmitable,” Dieffenbach said in referring to the current antiviral medication that makes HIV undetectable in the human body and prevents the virus from being transmitted to another person through sexual relations.
“That really is a rallying cry for people living with HIV that you can become fully suppressed and live knowing that there is no virus in your body as long as you take your pill, and you are free to love,” he told the Blade. “And that’s a wonderful thing.”
Although he didn’t say so directly, Dieffenbach made it clear that he and other government and private industry researchers working on an AIDS vaccine and an HIV/AIDS cure know that people with HIV can live a full and productive life as the push for a vaccine and cure continues.
Dieffenbach said a dramatic difference in the genetic makeup between the coronavirus and the AIDS virus is the reason why an AIDS vaccine has yet to be developed after more than 20 years of vaccine research while a COVID-19 vaccine was developed in a little more than a year.
“Once a person becomes HIV positive, that individual is HIV positive for life,” he said. “There is no going back. There is no spontaneous cure.” By contrast, Dieffenbach points out that with coronavirus, just five percent of those who become infected become seriously ill and are at risk of dying. He said between 35 percent and 40 percent of those infected with coronavirus are asymptomatic and often are unaware that they were infected.
“So, the human immune system by and large does a pretty good job of fighting off the coronavirus,” he said. That, among other factors, has made it possible to develop an effective COVID vaccine sooner than an AIDS vaccine, according to Dieffenbach.
Washington Blade: Where do things stand now in the progress of developing a cure for HIV and AIDS?
Carl Dieffenbach: So, let’s talk a moment about what we are doing in the space of trying to achieve a cure for HIV. Clearly, this is one of the two major research programs or research goals remaining in HIV – an effective and durable vaccine and then a cure that allows people to not take an antiretroviral [drug] and still live the ‘U’ equals ‘U’ [undetectable equals untransmitable] life.
What we want is a cure that really allows people to be free of HIV. And that can be achieved in two ways. You could see the HIV be eliminated or eradicated from the body. You would call that a sterilizing cure. And the other would be more of an immunological or other means of control that would suppress the virus similar to the way the antiretrovirals do, but it’s using the natural immunity, the induced immunity that the human body is capable of generating.
Up until recently there hadn’t been examples of an individual that had achieved that kind of cure. Just recently there was one reported. The big program we have in cure research is called the Martin Delany Collaboratories for Cure Research. And Marty was one of the lead activists in the very early days of HIV through the ‘90s. And he really pushed NIH very, very hard to not forget about a cure and to really focus on the best possible anti-virals.
He was just a strong leader and a really wonderful person who just pushed constantly the way you would hope the activist community would continue to try to drive improvements, even when things were going well. So, we felt it was a great way to honor Marty to name the program after him. This program has been around for a little over a decade and it gets more sophisticated and better every cycle.
And the two methods I mentioned – the ability to eliminate the virus completely and establish an immunologic or some other means of control – are major themes of these programs. It’s still in the very early days. There are limited clinical trials ongoing, but they’re very exploratory. There are maybe hints of things coming in the next couple of years. But it remains in the very early days. In some ways it’s similar to where we are with vaccines where we’ve had a little bit of success but nothing really that we then can say this is the vaccine for the future.
So, these two types of research – a vaccine and cure – remain our top research priorities. And we will continue at this until we have HIV vaccines and the abilities to cure, because we cannot really control and eliminate the epidemic without either of those two strategies.
Blade: Can you talk a little about the human trials that are going on now for a possible HIV cure being conducted by the Rockville-based company American Gene Technologies?
Dieffenbach: That’s right. One approach for achieving a cure are these gene-based strategies. There is a company that has a strategy for a gene-based treatment that they have been working on for a number of years. And that has been moving forward. And the proof will be in the pudding when we have a sufficient number of people in a way that are truly evaluated.
There are also strategies that look at ways of using what amounts to scissors, molecular scissors that can go in and chop out the virus. So, there are a number of strategies that people are using or considering for this idea of elimination of the reservoir, including the gene therapy method that we were just discussing.
Blade: The company conducting the gene therapy trials has said the treatment they hope will lead to a cure requires taking blood from someone, altering the genetic makeup of certain cells, and re-infusing the blood back into their body. Is that something that would be practical for treating a large number of people?
Dieffenbach: So, all of these gene therapy strategies are in the very experimental stage. They have to do something called ex-vivo transduction. That’s fancy words for saying what you just said. You take cells out of the human body, alter them by adding the new therapeutic and incorporate it into the cell, and re-infuse those cells back into the human body. So, first you start with one cell type like fully differentiated lymphocytes and then you move on.
The ultimate goal will be to get it so you can take a shot, where the shot would go in with the gene therapy and basically go into cells and immunize the cells in such a way that they provide protection from HIV infection as well as elimination of existing copies of HIV. So, we’re many steps away from that.
Blade: Some people may be asking why a COVID vaccine has been developed in just over a year since the worldwide COVID outbreak, but an HIV vaccine has not yet been developed after 20 or more years of research. Is there something different with the coronavirus as opposed to the HIV virus that might explain why we haven’t had an HIV vaccine at this time?
Dieffenbach: I think this is a really important point. And I want to talk about two different activities. One is the differences between the viruses themselves. With coronavirus, five percent of people who become infected with coronavirus actually get sick and get into a hospital and have near death experiences. Thirty-five to 40 percent of people who get infected with coronavirus are actually never aware that they were infected.
So, the human immune system by and large does a pretty good job of fighting off the coronavirus. But it is incredibly infectious. It is spread by aerosol. With HIV, it is transmitted sexually. It’s transmitted through blood and other bodily fluids. Once a person becomes HIV positive, that individual is HIV positive for life. There is no going back. There’s no spontaneous cure. We’ve had 70 million people around the world acquire HIV. By last count, there may be one person in all the years that may have spontaneously cleared their HIV infection. That took 12 years of that person’s life.
It is a rarity. So, from that perspective the type of immunity that you need to induce by a vaccine is so fundamentally different for coronavirus and for HIV. So, that’s the first step.
The second thing is why were we so successful with the coronavirus vaccine? It wasn’t dumb luck. Going back to the earliest SARS outbreak and through MERS and through other respiratory viruses the research team here at NIH has been looking at ways of building the better mouse trap, building a better immunogen. Take a part of the virus and make it the best it could be in terms of presenting or showing itself to the human immune system so that you get an incredibly robust quality response. And that was the work that was done at the VRC, the [NIH] Vaccine Research Center.
So, when that group first published their work on what we call this stabilized spike we offered that technology to all the vaccine manufacturers. And Moderna, Pfizer, and J&J all chose to use this modified version. AstraZeneca and Oxford chose different paths. The Chinese and the Russians chose a different path. And I think the quality of the vaccine and the effectiveness of the vaccine shows in part because of the genetic engineering that we have done to make it the best immunogenetic it can be.
So, it was a two-fold thing. We built a better vaccine to tackle a disease that really natural immunity can work well on. That’s one of the reasons why our vaccines – the Moderna, the Pfizer, and the J&J are still quite active against all these variants. It’s because their immune response was so robust. So, it was probably six to ten years of work that led us to that exact moment when SARS-CV2 came along that we know what to do with this. We were able to design a vaccine based on all that previous work within a very short period of time and start clinical trials within 60 days of identifying the coronavirus sequence. It wasn’t magic. It was hard work.
That’s a great story. There are so many unsung heroes in this. And it’s a great thing to be part of that we – NIH – could make it so it wasn’t just a proprietary thing for us. But we were able to give the world a way of making the best vaccine possible and to allow the companies to pick it up and run with it. So, again, at the end of the day the vaccines that I think we’ll come back to rely upon were made with this construct that was developed here through years of research.
Blade: Is there anything I did not ask you that is relevant to the HIV research?
Dieffenbach: Well, just to close the loop, so now that we learned all those lessons from the coronavirus vaccine, we’re going back to HIV vaccines and applying some of the rules and technologies and things that we’ve learned. Now we’re going back and looking at that more carefully and trying different things. And thinking about how we can build a better HIV vaccine based on what we know for a coronavirus vaccine.
So, we’re trying to complete the cycle. We started with HIV. We developed the platforms, applied it to coronavirus. And now we’re trying to close the loop.
Blade: You’ve been saying that these clinical trials for an AIDS vaccine have been going on for a while. Do you recall when the first AIDS vaccine trial started?
Dieffenbach: The very first trial for an AIDS vaccine was done in the ‘90s. And it didn’t work. It was a single protein. It induced antibodies. But the antibody did not react with the intact viruses. So, it failed. And that was the AIDS vax experience.
Blade: Do you remember when in the ‘90s that was?
Dieffenbach: The papers were finally published in 2003. So, the studies started in the late 90s and were completed in the early 2000s.
Blade: So, it appears that happened around the time the effective anti-retroviral drugs became available?
Dieffenbach: The highly active anti-retroviral therapy first made its debut in 1995. And that was a combination of AZT, 3TC, and either Crixivan, the protease inhibitor, or a different protease inhibitor from either La Roche or Abbott. And those drugs were quite effective in preventing the virus and helping people. But they all had tremendous side-effects as you will remember. And we then got better and better and better therapies where we are now at one pill once a day.
That is my background in this. I came from the drug side working with the companies back in the early ‘90s to bring those along. And I grew up in this field and then graduated to director of AIDS and then continued on to therapy and cure and vaccines ever since. I’ve been director since 2007.
Md. biotech company’s HIV cure project clears first hurdle
‘We all have something to be excited about’
American Gene Technologies, the Rockville, Md., biotech company, has announced that the first patient to receive its genetically engineered treatment therapy aimed at curing people of HIV/AIDS encountered no adverse side effects from the treatment.
In an Aug. 2 statement, AGT said that based on the data obtained from Patient One in its Phase 1 human trial of its HIV treatment called AGT103-T, the U.S. Food and Drug Administration’s Data and Safety Monitoring Board voted unanimously to allow AGT to continue its HIV cure program without modification.
“The AGT103-T pipeline is a therapy for treating HIV disease,” the company’s statement says. “The therapy is designed to induce durable viral suppression by delivering therapeutic genes to the recipient’s immune cells,” it says. “The resulting immune cells are expected to survive attack by HIV and durably suppress the virus at undetectable levels without the need for antiretroviral treatment.”
The thumbs up decision by the Data and Safety Monitoring Board allows the company to continue its clinical trial with more participants to further confirm the HIV treatment’s safety outcome. The next phase in the trials will be to determine the treatment’s effectiveness in fully protecting the human body from HIV.
“We have six more patients,” said AGT CEO Jeff Galvin in referring to the patients who will be tested for possible adverse side effects in the coming weeks. Galvin spoke at a July 29 gathering to celebrate the success of Patient One at AGT’s headquarters offices in Rockville.
“If this works, they will be permanently immune from HIV,” he said. “Just think what this can do with the epidemic. We all have something to be excited about,” he told the gathering of about 100 people.
“Keep your fingers crossed. Let’s all keep hoping and praying,” Galvin said. “We will know by the middle of next year,” he said, referring to when the human trials will likely determine whether the AGT103-T treatment, which has successfully stopped HIV from infecting human cells in laboratory experiments, will work just as effectively on people with HIV.
92% of LGBTQ+ adults have received at least one dose for COVID-19
59% of LGBTQ+ respondents reported Covid-19 made them feel socially isolated, & 50% reported that it impacted their mental health.
NEW YORK – A summary of data collected as part of the annual LGBTQ+ Community Survey by the Human Rights Campaign Foundation in partnership and supported by The Rockefeller Foundation in New York City, found that the vast majority – 92% – of LGBTQ+ adults surveyed in the United States had received at least one vaccination for Covid-19.
Although vaccination rates vary somewhat within the LGBTQ+ community, the rates across race and ethnicity, gender identity and sexual orientation, and age are well above the rates for various general adult populations where the data are available:
- By race and ethnicity, 90% of Latinx respondents, 85% of Black respondents, 96% of Asian or Pacific Islander respondents, and 85% of Native American/Alaskan and Middle Eastern/North African LGBTQ+ adults, among other race identities have received at least one dose of a Covid-19 vaccine.
- By gender identity and sexual orientation, 92% of cisgender lesbian and bi+ women, 93% of cisgender gay and bi+ men, and 92% of transgender and non-binary people have received at least one dose of a Covid-19 vaccine.
- By age, 91% of LGBTQ+ respondents aged 18-34, 92% of LGBTQ+ respondents aged 35-5, and 94% of LGBTQ+ respondents aged 55 and older have received at least one dose of a Covid-19 vaccine
While vaccination rates are high, Covid-19 took a toll on well-being among respondents. The survey finds that 59% of LGBTQ+ respondents reported that Covid-19 made them feel socially isolated, and 50% of respondents reported that it impacted their mental health.
“Increasing vaccination rates among communities of color is a major focus for us, and working with the Human Rights Campaign Foundation gives us the opportunity to better understand the impact of Covid-19 on LGBTQ communities of color. We look forward to continuing our support and outreach.” said Otis Rolley, Senior Vice President of Equity and Economic Opportunity at The Rockefeller Foundation.
The data finds the Covid-19 pandemic led to social and financial loss, especially among LGBTQ+ people of color:
- 21% of LGBTQ+ adults surveyed reported that a close family member or friend has died from Covid-19
- LGBTQ+ people of color surveyed reported higher levels of loss due to Covid-19 compared to white LGBTQ+ people:
- 30% of Latinx LGBTQ+ respondents
- 28% of Black LGBTQ+ respondents
- 25% of Native American/Alaskan and Middle Eastern/North African LGBTQ+ respondents, among other race identities
- 18% of Asian/Pacific Islander LGBTQ+ respondents
- 17% of white LGBTQ+ respondents
- 36% of LGBTQ+ respondents reported that a close friend or family member has become very sick from Covid-19
- 24% of LGBTQ+ respondents reported that Covid-19 has negatively impacted their financial well-being
- LGBTQ+ people of color surveyed are more likely than white LGBTQ+ people to have experienced a negative financial impact during the pandemic:
- 33% of Native American/Alaskan and Middle Eastern/North African LGBTQ+ adults, among other race identities
- 26% of Asian/Pacific Islander LGBTQ+ adults
- 26% of Latinx LGBTQ+ adults
- 25% of Black LGBTQ+ adults
- 22% of white LGBTQ+ adults
“There are many reasons why LGBTQ+ vaccination rates may be higher than the general population, including higher percentages of the LGBTQ+ community being liberal, living in blue states, and living in urban areas,” said CMI Senior Director of Research, David Paisley. “While participants had strong education levels, those with no more than a high school diploma still had an 87% vaccination rate. We also see that Covid isolation significantly impacted LGBTQ+ people, which may have motivated quick vaccination to reenter the community.”
The new data build on the HRC Foundation’s previously released reports, including the most recent report, “Covid-19 and the LGBTQ Community: Vaccinations and the Economic Toll of the Pandemic,” which was released as a part of the HRC Foundation’s vaccine public education campaign: “For Ourselves, For Each Other: Getting to the Other Side of the Pandemic.” The HRC Foundation has also partnered with the Black Trans Advocacy Coalition on a resource, “Finding Financial Stability During Turbulent Times,” with steps and advice for those who may be struggling to make ends meet during these difficult times. Read more about the HRC Foundation’s efforts during Covid-19 here.
The Rockefeller Foundation is supporting the Human Rights Campaign Foundation on a number of Covid-19-related projects to support research and community education to reach LGBTQ communities of color during this crisis through The Rockefeller Foundation’s Equity-First Vaccination Initiative. Learn more here.
Cornell University study on impact of discrimination on LGBTQ of color
Around 25% of LGBTQ youth have attempted suicide, but the rates are starkly higher for LGBTQ youth of color than their white counterparts
ITHACA, NY. – Cornell University’s What We Know Project in conjunction with a coalition of leading LGBTQ rights groups last month published a comprehensive curation of data on studies that chart the intersection of anti-LGBTQ and racial discrimination.
The findings found that discrimination inflicts profoundly greater harm on LGBTQ people of color in a wide range of areas, including grossly disproportionate rates of: experiencing discrimination over the past year, poorer mental and physical health, greater economic insecurity, and attempts to die by suicide.
In addition, LGBTQ people of color are more likely than white LGBTQ people to live in states without protections against discrimination and that state anti-LGBTQ laws harm LGBTQ people.
“This research brief makes clear the tangible harms that discrimination inflicts on LGBTQ people of color, and the urgent need for public policy that reflects what the research tells us about how we can reduce those harms,” said Dr. Nathaniel Frank, the study’s author.
LGBTQ people are more likely than non-LGBTQ people to be people of color, and Black LGBTQ Americans are disproportionately likely to live in states without protections against discrimination. For example, 42% of LGBT people are people of color compared to 32% of non-LGBT people and the majority of Black LGBT Americans live in the South (51.4%, more than twice the share of any other region), where most states lack anti-discrimination protections.
LGBTQ people of color face higher odds of discrimination than both non-LGBTQ individuals and LGBTQ white people. For example, LGBTQ people of color are more than twice as likely to experience anti-LGBTQ discrimination (slurs or other verbal abuse) when applying for jobs than white LGBTQ individuals (32% vs. 13%). LGBTQ people of color are more than twice as likely as white LGBTQ people to experience anti-LGBTQ discrimination when interacting with the police (24% vs. 11%).
Black LGBT Americans are more likely to experience economic insecurity than Black non-LGBT Americans. For example, the majority of Black LGBT people (56%) live in low-income households (below 200% of the federal poverty level) compared to 49% of Black non-LGBT Americans, and Black LGBT adults are also more likely to experience food insecurity than Black non-LGBT adults (37% compared to 27%).
Hundreds of studies conclude that experiencing anti-LGBTQ discrimination increases the risks of poor mental and physical health, including depression, anxiety, suicidality, PTSD, substance use, and psychological distress.
LGBTQ people of color face disproportionate odds of suicidality, which is linked to discrimination. For example, while 12% of white LGBTQ youth attempted suicide, the rate is 31% for LGBTQ Native/Indigenous youth, 21% for LGBTQ Black youth, and 18% of LGBTQ Latinx youth.
While supportive laws, family, and peers lower the risk of poor health outcomes for LGBTQ people of color, anti-LGBTQ state laws inflict tangible harm on sexual minority populations. For example, states with “denial of service” laws that give license to discriminate against LGBT residents between 2014 and 2016 were linked with a 46% increase in LGBT mental distress. Black LGBTQ youth who reported high levels of support from at least one person, or who had access to an LGBTQ-affirming space, reported attempting suicide at lower rates than those who lacked such support (16% vs. 24%).
Supportive laws, family, and peers lower the risk of poor health outcomes for LGBTQ people of color.
• Suicide attempts by LGBT youth dropped by 7 percent in states that legalized same-sex marriage.22
• The corollary is that anti-LGBTQ state laws inflict tangible harm on sexual minority populations. States with “denial of service” laws that give license to discriminate against LGBT residents were linked with a 46% increase in LGBT mental distress.23
• Black LGBTQ youth who reported high levels of support from at least one person, or who had access to an LGBTQ-affirming space, reported attempting suicide at lower rates than those who lacked such support (16% vs. 24%). Those with high levels of family support had rates of past-year attempted suicide nearly one third as high as those who lacked such support (22% vs. 8%).24
• Protective measures that have been found to help reduce anxiety, depression, and suicidality among LGBTQ youth include: Establishing inclusive practices and anti-discrimination policies; peer, community, and family support, including dedicated school groups; access to affirmative mental health and social services; societal confrontation of attitudes and norms that exacerbate minority stress; and practitioner training and interventions designed to disrupt negative coping responses and build resilience.
Experiencing discrimination is associated with greater odds of harm to psychological and economic well-being, which is reflected in data on disparities for LGBTQ people of color.
• Hundreds of studies conclude that experiencing anti-LGBTQ discrimination increases the risks of poor mental and physical health, including depression, anxiety, suicidality, PTSD, substance use, and psychological distress.
• LGBT people of color have work-place experiences that are more negative than those of white LGBT employees, reporting that their success and work-life balance are fostered less extensively, they have less transparent evaluations, and they are respected less by supervisors.
• Among LGBTQ people surveyed, 51% of Black respondents say discrimination harms their ability to be hired, compared with 33% of white respondents; 41% say it has an impact on their ability to retain employment, compared with 31% of white respondents; 77% of Black respondents report that discrimination impacts their psychological well-being, a rate nearly 50% higher than the total LGBTQ survey population.
• While racial discrimination on its own is not associated with mental health disorders, the combination of racial discrimination with gender and/or sexual orientation discrimination is significantly associated with increased odds of a past-year mental health disorder.
LGBTQ people of color face disproportionate odds of suicidality, which is linked to discrimination.
• Around 25% of LGBTQ youth of all races have attempted suicide, but the rates are starkly higher for LGBTQ youth of color than their white counterparts: While 12% of white LGBTQ youth have attempted suicide, the rate is 31% for LGBTQ Native/Indigenous youth, 21% for LGBTQ Black youth, and 18% for LGBTQ Latinx youth.
• In a 95%-non-white LGBT sample, those who report experiencing anti-LGBT victimization (such as bullying and harassment) are 2.5 times more likely to report a past-year suicide attempt compared to those who do not report victimization.
• Black LGBTQ youth who experience anti-LGBTQ discrimination face twice the rate of past year suicide attempts compared to youth who do not (27% vs. 12%). Black LGBTQ youth who experience race-based discrimination also face higher odds of attempting suicide than those who do not (20% vs. 14%).
• Black LGB adults are over 40% more likely to have made a serious suicide attempt in their lifetime than white LGB adults.
• Latinx and Native American/Pacific Islander LGBT youth are 50% more likely to attempt suicide than white LGBT youth. Latinx LGBT girls are nearly twice as likely to attempt suicide than white LGBT youth.
• LGBTQ students who experience discrimination “based on multiple social identities” report more use of deliberate self-harm compared to LGBTQ students who experience racial discrimination alone or who do not experience significant discrimination of any kind.
Reflecting on the study’s findings, key executives from participating LGBTQ Advocacy groups weighed in:
“These painful figures highlight an indisputable link between discrimination, economic security, mental and physical health. People with multiple stigmatized, marginalized social and political identities, particularly Black LGBTQ+/Same Gender Loving people, bear a disproportionate amount of the weight illustrated by the data in this study. Statutory equality for LGBTQ+ people nationwide is a necessary foundation to remove the gaps in existing civil rights laws if we are to ever live up to our country’s founding promises of life, liberty, and the pursuit of happiness for all,” said David Johns, Executive Director, National Black Justice Coalition.
The majority of Black LGBTQ people live in the South, with nearly half (44%) of all Black women couples raising children. Even today, most of these states still do not protect LGBTQ people from discrimination and have overtly discriminatory laws on their books. It is no wonder the disparities are so profound and it is a testament to the strength and resilience of our people that they are doing as well as they are. For our community and for our children it’s time for federal action!” said Kierra Johnson, Executive Director, National LGBTQ Task Force.
“This important brief only further solidifies what we have known for a very long time—the combination of racism and anti-LGBTQ discrimination has serious and long-lasting effects for the health and well-being of LGBTQ people of color. This research highlights why federal non-discrimination protections are overdue and vital to protecting the most some of the most underrepresented and vulnerable members of our community. Federal anti-discrimination protections are absolutely necessary in protecting and supporting all LGBTQ people, and this is especially true for LGBTQ people of color,” said Imani Rupert-Gordon, Executive Director, National Center for Lesbian Rights.
“Study after study shows that nondiscrimination protections improve economic opportunities, public safety, and physical and mental well-being of LGBTQ people. It is well past time for the essential protections available only in some of our states and cities to be extended to all LGBTQ Americans, especially LGBTQ people of color, who are disproportionately burdened by the lack of protections, ” said Kasey Suffredini, CEO and National Campaign Director, Freedom for All Americans.
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