The Journal The Authority on Global Business in Japan

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Thirty-five years ago, an acronym emerged on the US West Coast to describe an unusual, newly discovered infection found among homosexual men: gay-related immune deficiency (GRID).

It was caused by the human immunodeficiency virus (HIV), and four years later the first HIV-positive Japanese patient was identified—a gay man residing in San Francisco. More than three decades later, what was once known as GRID is called acquired immune deficiency syndrome (AIDS), and the disease affects a broad swathe of the global population. Women represent about one-fifth of AIDS sufferers today.

Dr. Francoise Barré-Sinoussi co-discovered the HIV virus in 1983.

Dr. Francoise Barré-Sinoussi co-discovered the
HIV virus in 1983.

PAVING THE WAY
Since the first diagnosis in 1981, female researchers and leaders have been instrumental in treating the disease once thought to be limited to men and intravenous drug users. Perhaps the most well-known is Dr. Francoise Barré-Sinoussi, the 2008 Nobel Laureate credited with co-discovering the HIV virus in 1983. Barré-Sinoussi will be in Japan November 7–9 as part of AstraZeneca Japan’s Nobel Prize Inspiration Initiative. The event is designed to inspire young researchers and women in the fields of science, technology, engineering, and mathematics (STEM).

Mary Nishikawa, now an academic trainer for Japan’s Cactus Communications K.K., was also involved in early AIDS research in the 1980s, at New Jersey’s F. Hoffmann-La Roche lab. Nishikawa credits her supervisor, Dr. Herbert Weissbach—then the director of the Roche Institute of Molecular Biology—with having given her “the job of a lifetime . . . playing a small part in the development of the drug that eventually saved millions of lives.” This drug was Saquinavir, a protease inhibitor known by its brand names Invirase and Fortovase, an early HIV medication approved by the US Food and Drug Administration in 1995.

Weissbach, she told The Journal, inspired everyone to feel that “work on every minute piece of the puzzle mattered”—even though she and her team did not realize at the time how important their research was. Today, HIV/AIDS patients mostly rely on combined antiretroviral treatments (ARTs) to reduce the amount of HIV in the bloodstream to very low levels, sometimes enabling the body’s immune cells to rebound to normal levels. Even when patients respond well to ART, however, it does not cure HIV. The drugs can be costly and cause serious side effects. Furthermore, because HIV constantly mutates, the virus often develops resistance, rendering medications ineffective.

DIVERSITY BREEDS INNOVATION
While Barré-Sinoussi and Nishikawa were making progress in the lab, key HIV/AIDS milestones were taking place in the public realm. The year 1985 marked the first International AIDS Conference, held in Atlanta, Ga. In July 2016, the 21st International AIDS Conference (AIDS 2016) convened in Durban, South Africa, attracting more than 15,000 participants.

One of the headline speakers this year was Dr. Jintanat Ananworanich, MD, PhD, associate director for therapeutic research at the US Military HIV Research Program. Ananworanich presented ground-breaking findings from her study of the HIV viral reservoir in children infected with HIV. The size of this reservoir has often been cited as a marker of how difficult it will be to achieve remission; the smaller the reservoir, the easier to control the virus. Those diagnosed early typically have a smaller viral reservoir and thus, logic follows, they can more easily achieve remission. Ananworanich found, however, that ART treatment during such acute infection had no impact on delaying a viral rebound. Her work is significant for researchers who have long focused on reducing the size of the reservoir, which may not be necessary to achieve remission.

In addition to the first global AIDS conference, 1985 saw the launch of amfAR—The Foundation for AIDS Research—an international nonprofit co-founded by actress Elizabeth Taylor. The organization funds a diverse pool of global researchers whose innovation supports the search for a cure.

Rowena Johnston, PhD, is vice president and director of research at amfAR. “Innovation can come in different forms: a new scientific idea, a new way to execute a scientific plan, a new way to fund the research. Our grants support scientists who bring ideas from outside of HIV to bear on curing HIV,” she told The Journal. The nonprofit was instrumental in funding pioneering work that explores the use of ART to prevent mother-to-child transmission of the virus.

In 1994, a definitive clinical trial known as ACT G076 showed that the use of ART could cut the risk of mother-to-child transmission by two-thirds. The same year, three other high points were hit in the fight against AIDS.

1994: MAJOR MILESTONES
The US National Institutes of Health issued guidelines in 1994 requiring grant applicants to address “the appropriate inclusion of women and minorities in clinical research.” This declaration followed recognition of the growing number of women living with AIDS. In 2002, the number of female to male sufferers reached its peak of just above 50 percent.

The year 1994 also marked Japan’s hosting of the 10th International AIDS Conference. Held in Yokohama, the conference was the first to be staged in Asia. Many people saw this as a turning point in Japan’s history with the epidemic, which until then had been in the shadows of Japanese society. Dr. Aikichi Iwamoto, who has chaired the National HIV Surveillance Committee at the Ministry of Health, Labour and Welfare since 2005, encourages Japanese patients to speak up about the need to improve medical care and the social environment surrounding the disease. Many “defer from demanding improvements because of the sense that they had brought the disease on themselves.

“The social stigma needs to be changed to incorporate more patients’ voices into public policy,” Iwamoto said in 2014, in response to data showing the number of people living with HIV/AIDS had risen slightly in Japan in 2013. In most other industrialized nations, including the United States, infection figures have been falling since the beginning of the millennium.

Japan’s HIV cases represent a small fraction of those in the United States, but a few factors are cause for concern. From 2000 to 2014, the number of reported cases of HIV in the country more than doubled; in addition, the number of people getting tested has been falling. Seventy percent of all cases of HIV infection are sufferers in their twenties or thirties.

In the lead-up to and the momentum following the 1994 AIDS conference in Yokohama, many public and nonprofit organizations were founded to support patients, such as the Japan HIV Center, the Japan Society for AIDS Research, and the government’s AIDS Core Care Hospital system. Campaigns targeting the at-risk youth population were launched sporadically, including a concert by popular Japanese all-male band Exile that was broadcast online. A temporary HIV testing center was set up near the main stage. Testing also became free and anonymous at public health centers in the 1990s. Still, many international activists suggest Japan must take more action to educate youth about risky behavior that could lead to contracting HIV.

Our main weapons in the fight against HIV/AIDS remain early testing, treatment, and surveillance of the constantly mutating virus. To this end, also in 1994, Abbott International set up its Global Surveillance Program, and has since collected more than 40,000 blood specimens of HIV and hepatitis from collaborators worldwide. The goal of the program is simple: Keep track of new strains of these viruses so that the tests developed to detect them can keep pace.

Global Village at 2012 International AIDS Conference on July 22–27 in Washington DC

Global Village at 2012 International AIDS Conference on July 22–27 in Washington DC

NEW SOLUTIONS, OLD PROBLEMS
Mary Rodgers, PhD, is currently head of Abbott’s surveillance program, which is based in the Chicago area. Rodgers coordinates the intake of leftover blood draws from clinicians and blood banks across five continents. Along with her five colleagues, who are part of a larger group of infectious disease researchers, Rodgers attempts to classify and sequence the multitude of HIV strains across the globe. Their work is crucial in the development of tests than can detect all mutations of the virus.

“I was ultimately drawn to infectious disease research to make a difference in healthcare,” she told The Journal. “I want to find new solutions to old problems.”

Throughout her career, Rodgers has benefited from female scientific role models, such as her graduate advisor at Harvard University, Priscilla Yang. “I’ve followed in her footsteps, establishing a career while balancing a family,” she shared.

Rodgers was due to have her second child just before this article went to print, and plans to return to work after six weeks’ maternity leave. Expecting a daughter, she admits to always considering ways to encourage young women to enter science, technology, engineering, and math (STEM) fields. “It’s also important to encourage boys to see women as scientists. I see less women in scientific leadership roles, so I hope that by working in this [management] position, I can serve as an example to others.”

She acknowledges how women have “contributed every step of the way” in HIV/AIDS research, pointing to long-time Abbott employee Robin Gutierrez, who helped develop the first HIV test used to screen the blood supply in the 1980s.

When asked what comes next for the AIDS pandemic—vaccination or cure—Rodgers opts for the former, suggesting it is perhaps “our best bet in the long term.”

COUNTDOWN TO CURE
On the other end of the research spectrum, at AIDS 2016, Barré-Sinoussi said: “HIV cure research has the potential to alter the future of this epidemic . . . Science is now telling us that a remission of HIV infection allowing patients to live free from antiretroviral drugs should be achievable.”

Rowena Johnston and amfAR are similarly focused on finding “the scientific basis of a cure,” rather than a vaccine, by 2020. The institution has invested $100 million in research “to answer critical roadblock questions and provide the scientific knowledge base on which the design of a cure will rely.” In November 2015, it announced the launch of the amfAR Institute for HIV Cure Research, a San Francisco-based body that brings together the finest minds working in HIV research.

Certainly now, as in the past, female scientists are invaluable in enacting the vision of an AIDS-free planet within our lifetime.

Brandi Goode is a freelance writer and editor based in Manila, and previously Editor-in-Chief of The Journal.
Since the first diagnosis in 1981, female researchers and leaders have been instrumental in treating the disease.