Linos Vandekerckhove, MD, Enlists Patients to Help Codesign Protocols
by Jeannie Wraight
Ihad the opportunity to speak with Linos Vandekerckhove, MD, of the HIV Cure Research Center at Ghent University in Ghent, Belgium. What struck me most about Dr. Vandekerckhove, in addition to his commitment to the discovery of an HIV cure, was his very natural desire to include people living with HIV in the research process——not only as subjects but as individuals with valuable experience and knowledge that could greatly contribute to the research process. In our conversation, I found Dr. Vandekerckhove to be not only a dedicated researcher but a good man with a strong desire to end HIV.
Jeannie Wraight: So take me to the beginning. What led you to a career in HIV research? Why HIV?
Linos Vandekerckhove: As a medical doctor I worked in Rwamagana in Uganda in 1998 and in Preteria, South Africa, in 2000, where I was exposed to huge numbers of HIV patients. So for me there wasn’t many options after that as I wanted to dedicate my efforts to finding solutions and helping people who were really in need of access to treatment, as well as reducing the number of new infections and hopefully someday finding a cure for them.
You’ve utilized some rather unique sources of funding research, including crowdfunding and receiving part of the proceeds from an anti-stigma campaign, Positively Alive. There certainly is a greater emphasis on cure research yet at the same time we’ve experienced a sort of HIV donor fatigue for quite some time. Do you feel it’s gotten more difficult or easier to raise money for cure research in recent years.
What I’ve seen is [that] the more you’re able to create better and higher level research, the easier it is to get grant money. Also, what I did from very early on was to take patients on the path of research and involving them in protocol design, and that helped to create awareness and funding as well as spreading the message and study findings. As a medical doctor seeing patients and having close contact, this is not a difficult thing for me to do. It’s something I like to do and has helped me a lot over the years.
Can you tell me about your lab’s research?
We do a lot of work in designing new assays and, with others, introducing different techniques and software to quantify HIV DNA in viral reservoirs using digital DROPPLET PCR assays. We do a lot of teaching about this and have a four-day course each year. We also have been working hard on looking at the full length of the virus and rather than quantifying it, looking at it from a qualitative [angle], so evaluating how intact it is, looking where it is integrating and looking at new assays for this. In addition, we also look at more in-depth pathogenesis——which pathways are active, exhaustion markers, how the viral reservoir persists over time and also what T cells can offer in terms of cure potential, which is our last branch of research.
We also did a study, published in Cell Host and Microbe, where we worked very closely with patients to look at different reservoir sites such as the provirus in the lungs and the small and large intestines. Then we stopped treatment and allowed the virus to come back. We then linked the sequences from the body compartment samples to try to determine the origin of viral rebound. [Author’s note: this study has received a great deal of attention.] The patients were very helpful in co-designing and helping us. For example, whether general anaesthesia was used, which was a major decision that was made by the patients themselves to minimize coming [in] for many individual procedures. This study is important because while we already knew there was virus everywhere, we could never link this to [viral] rebound and the link to rebound is crucial. Quantitatively, the gut is the biggest reservoir, so some might say if we eradicate the virus from the gut we could cure some people. But we know that’s not going to work because you will always have virus from other sites rebounding. This is an important message because many have asked over the past year: If we have a drug that penetrates sanctuary regions better, could we then eradicate HIV? I think no, this is not a solution and will not pave the way to a cure.
Once or twice a year, the press will latch on to a piece of either overzealous, misunderstood or misinterperted research and proclaim that an HIV cure is near. In your opinion, realistically, where do you think we’re at on the spectrum of curing HIV, either by eradication or a remission strategy?
We hear that message indeed too often. I strongly believe that an HIV cure will come one day. Two major points support this. The first is that we have made a lot of progress in better understanding HIV, where it hides, and the composition of full-length virus in certain integration sites in the human genome do matter. Second, enormous progress has been made by biotech to perform antibody production on a large scale, etc. We know today how to tackle and edit certain genes using technology that only emerged in the last five years. Hence if we count these two together and add heavy patient commitment towards the path of finding a cure, then we are definitely moving in the right direction.
Positively Alive, the anti-stigma campaign mentioned above which donates part of their proceeds to Vandekerckhove’s HIV Research Cure Center, is conducting a Kiss HIV Stigma Goodbye campaign challenge to help fight stigma and would love your participation. For more information please visit their website at: https://www.positivelyalive.org/.
The interview has been edited for space.
Jeannie Wraight is the former editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in New York City.