In January 1983 Françoise Barré-Sinoussi discovered HIV – the virus that causes AIDS. Since then, the Nobel Laureate has worked tirelessly both to find a cure and treatments for the disease and to advocate on behalf of those living with HIV. Ahead of the 2019 Nobel Week Dialogue on risk, uncertainty and opportunity, we spoke to Barré-Sinoussi about her early days working on HIV/AIDS and her hopes and concerns for the future.

Why did you decide to become a scientist?

“When I was a child I was very interested in nature, I was very interested in earth and life science at school. Then, after high school, I began wondering to myself whether I would become a researcher in biomedical science or whether I would go to medical university. I was hesitating between both and finally decided to go to university and study science in Paris – originally for a crazy reason – I thought that studies at medical school were longer than studies at a science university. That was a mistake by the way!

I went to university to study science and I do not regret it at all because ultimately I have interacted a lot with clinical researchers, patients, clinicians and medical staff and found out that I was really motivated to try to bring benefit to patients through science.”

How did working with HIV change the way you think about science and your work?

“I was already working on the field of viruses – retroviruses and cancer. But what changed my life working with HIV was the direct interaction with clinicians, with patients, because before, even if I was involved in basic science I was in the lab but did not have direct interaction with clinical doctors and no interaction at all with patients. What changed my life was really the strong interactions with patients and patients’ representatives and understanding better their expectations from scientists. That’s what was critical.”

Did you find it hard to deal with those expectations from patients?

“HIV/AIDS was a bit special in a way that we were in the middle of a tragedy in the early years of HIV so, of course, there were a lot of expectations from patients. They came to us because they had many questions to ask and we did not have a direct answer to questions like: ‘Do you have any treatment for us?’. At that time we had nothing to propose.

But the dialogue between patients and us scientists was not so difficult because we very rapidly understood their expectations and we tried to adapt our language in a way that they could understand. We tried to explain very simply which kind of strategy we could seek in the future but told them the truth at the same time. Telling them it will take time, it will take several years before we can have a treatment for you.”

Today HIV infection is treatable, but not curable. What opportunities do you see for us to develop new strategies against HIV in the future?

“Speaking only in terms of science, the opportunities are to develop a vaccine and to develop novel therapeutic strategies and hopefully a cure for HIV. That means opening totally new areas for basic scientists in order to better understand the mechanisms which are implicated in the persistence of the virus on treatment today. It’s also an opportunity for basic scientists to understand the mechanisms that can be implicated in immune regulation of HIV, and even beyond HIV.

We already have information telling us that the residual chronic inflammation in patients must be controlled if we want to control the persistence of the virus. We also know that chronic inflammation is involved in many other diseases. So it’s an opportunity to understand better those mechanisms in HIV and in other diseases like cancer, cardiovascular disease or diabetes. There is an opportunity in many fields to discover novel predictors for vaccine efficacy, novel predictors for treatment efficacy and consequently to open the road also to precision medicine.”

And what do you see as the biggest risk in your field at the moment?

“For me the biggest risk would be to see a reemerging HIV/AIDS epidemic. That is really what I am extremely worried about. In some countries, in particular right now in Africa, the virus is, in newly infected people, almost already resistant to the treatment.

So, my worry is to see a situation which is quite similar to tuberculosis – to see a new epidemic where the virus is resistant to treatment. And we know that this risk is due to insufficient access to the tools that scientists have developed or of improper use of those tools and this is really a terrible risk for the future.”

What do you mean by tools?

“When I’m speaking of tools, I’m speaking about preventative tools and therapeutic tools and thinking about treatment today. We don’t have a vaccine. We don’t have a cure.

The treatment that has been developed for patients is also prevention because we know that if someone is treated early, the person not only has a life expectancy which is similar to someone who is not infected, but you have to take these treatments for life. The second thing is that when somebody is being treated, we know that they do not transmit to others because the virus is controlled on treatment. So there is a double benefit to that.

But if a person cannot take treatment regularly, then there is a risk for them to develop a form of the virus that is resistant to treatment and they could transmit this resistant virus to others, so that can be the start of a new epidemic.”

First published November 2019