‘Don’t stop now’: an endgame for HIV/AIDS

HBO’s ‘Countdown to Zero,’ featuring Fred Hutch researchers, shows the pandemic remains, but fresh hope abounds
Dr. Larry Corey and Dr. Julie McElrath
Fred Hutch HIV-research pioneers Dr. Larry Corey and Dr. Julie McElrath are featured in HBO's VICE documentary "Countdown to Zero." Robert Hood / Fred Hutch

Scientists and activists who have been battling HIV since the first cases were documented more than 30 years ago often cite two oddly contradictory challenges to their work: Half the general public seems to believe that the pandemic is over, at least in the United States. The other half thinks it’s such an overwhelming problem that we will never again achieve a generation free of HIV/AIDS.

A VICE special report, which aired on HBO on Tuesday, World AIDS Day, upended both of those perceptions.

By showcasing people with HIV from Seattle to South Africa, cutting-edge HIV researchers at Fred Hutchinson Cancer Research Center and elsewhere, activists such as U2 singer Bono and even the seldom-interviewed President George W. Bush, “Countdown to Zero” painted a clear picture both of a scourge that is very much still with us and the progress being made toward preventing and even curing it.

“There’s been a real explosion of knowledge in the last five years,” said virologist Dr. Larry Corey in the documentary. Corey, Fred Hutch’s president and director emeritus decades ago laid the groundwork for the first HIV treatments and is now leading the search for a vaccine. “I do think we’re having a renaissance in our knowledge to how we can get to the endgame and AIDS-free generation.”

The program is available on HBO Now and HBO GO and, for the next few weeks, streaming free via YouTube. A public screening is being held today in New York City’s Lincoln Center.

“Countdown to Zero” opens with a montage of photos and film clips from the pandemic’s beginnings in the 1980s: wrenching shots of young gay men wasting away from the disease and of protestors shouting, “Where are the drugs?” Such images largely disappeared – along with much of the public’s attention – in the mid-1990s, when scientists developed a cocktail of antiretroviral drugs that, if taken daily, can stop the virus from progressing to AIDS. Rather than facing an automatic death sentence, HIV-positive people with access to the drugs can live a normal lifespan, Corey said.

But VICE founders and correspondents Shane Smith and Suroosh Alvi didn’t linger in the past. The program quickly shifted to the present – the outbreak earlier this year of 175 HIV cases in rural Indiana fueled by an intravenous heroin and methamphetamine epidemic. Smith noted that it was in covering that epidemic for VICE that he asked himself, “How in 2015 is AIDS still surging in middle America? How is HIV surging at all? How much progress has been made since 1981,” the year the first cases were reported?

A cancer center and home to infectious disease research

To answer this, he came to Seattle to talk with Corey and Dr. Julie McElrath, director of Fred Hutch’s Vaccine and Infectious Disease Division and, like Corey, a physician-scientist who has been on the front lines since the epidemic’s beginning. Best known for its cancer research, including pioneering work in bone marrow transplantation, the Hutch has one of the largest infectious disease divisions of any cancer research center. It is home to international and national research efforts such as the HIV Vaccine Trials Network, or HVTN, the largest network working on developing and testing preventive vaccines, and defeatHIV, one of three federally funded consortiums working on a cure.

In addition to vaccine research, McElrath oversees a long-running study of a rare subset of people who were infected with HIV years or even decades ago but whose bodies control the virus without medication.

The VICE team documented one member of the study group, Rod Fichter, on his 95th visit to the clinic to give blood for the research project. Fichter, who has been HIV-positive for three decades, brought viewers – and the filmmakers – to tears talking about the loss of his partner to HIV decades ago, while he remained healthy.

“If I could have saved him, that would have been the best thing,” he said.

Fichter assumed that he would eventually get sick and die too. That didn’t happen.

“When I joined the study, I learned there was a group of people called nonprogressors,” he said. “If they can figure out how to replicate that in other people, maybe we can find a way to block it in people who don’t have it.”

‘I believe we are beginning to see the unimaginable.’

From Seattle, the program moved to South Africa, where the HVTN is overseeing a clinical trial testing a modified version of the so-called Thai vaccine, the only vaccine tested so far to show even modest protection against HIV. It was yet another reminder that HIV/AIDS is still very much present; of the 37 million people around the world with HIV, 25 million live in sub-Saharan Africa. In South Africa, about 19 percent of the adult population is infected and 2.3 million children have been orphaned because of AIDS.

Fred Hutch researcher Dr. Glenda Gray, president of the South African Medical Research Council and a the leader of the HVTN’s work in Africa, has battled HIV just as she had previously fought apartheid.

“What happened in this country was equivalent to a genocide,” she said of an earlier government’s denial that HIV – rather than poverty or poor nutrition – caused AIDS.

Today, despite the devastation, she sees hope, especially in efforts to prevent mother-to-child transmission.

“I believe we are beginning to see the unimaginable,” she said.

The VICE documentary traced this turnaround to the unlikely alliance between a Republican president and a rock star. VICE interviewed Bush on the Southern Methodist University campus in Dallas about the U.S.-led PEPFAR (President’s Emergency Plan for AIDS Relief) program and traveled with Bono, who co-founded the AIDS charity (RED), to Rwanda.

“Seldom has history offered an opportunity to do so much for so many,” said Bush, who was alerted to the devastation in Africa by his Secretary of State Condoleezza Rice and inspired in part by Bono’s “energy and faith.” Of his unilateral creation of PEPFAR – the largest amount of money ever put toward a single disease and one of the largest relief efforts ever undertaken in sub-Saharan Africa –Bush said, “The American people don’t understand how successful this effort was on their behalf.”

Bono called HIV/AIDS “the greatest pandemic in the history of the world.”

“HIV/AIDS demonstrated the injustice of the health system,” he said. “In Dublin [where Bono is from], you get two pills and live. In Kigali [the capital of Rwanda], you don’t, and die. Where you live decides whether you live.”

That is no longer the case, at least in Rwanda, where rates of HIV infection have been cut in half and mother-to-child HIV transmission eliminated in many regions.

Hope for a cure and an end to HIV/AIDS

In the opening montage, a patient with a face scarred by the lesions of Kaposi sarcoma, one of the hallmarks of AIDS, recounted how a doctor had refused to treat him by telling him, “There is no cure for AIDS, and there never will be.”

But in 2009, the world learned that at least one man – originally known as the “Berlin patient” and who later identified himself to be Timothy Ray Brown – has been cured. The VICE documentary interviewed the Seattle-born Brown on the Fred Hutch campus and also the little-heralded doctor who cured him, Dr. Gero Hϋtter, in his hometown in Germany.

In 2007, Brown had reluctantly agreed to a stem-cell transplant in Berlin, where he was then living. The immediate threat to his life was not HIV but a fast-moving leukemia that had failed chemotherapy. Hϋtter, his German blood cancer specialist, had the idea of curing both Brown’s cancer and his viral infection by finding a stem-cell donor who carried a rare genetic mutation that protects against HIV. It took a second transplant to cure the leukemia, and complications led to a lengthy recovery. But eight years later, Brown’s HIV has not returned.

Today several groups of researchers around the country, including defeatHIV, are using Brown’s cure as a blueprint to investigate a more widely applicable, less-grueling cure by modifying an HIV patient’s own cells to mimic the genetics of someone with natural resistance. VICE interviewed Dr. Carl June of the University of Pennsylvania in Philadelphia, who is investigating genetically modifying T cells – infection-fighting white blood cells that HIV targets – to make them resistant to the virus.

June did his post-doctoral training in transplantation biology in the mid-1980s at Fred Hutch with Nobel laureate Dr. E. Donnell Thomas, where he first became fascinated by T cell biology. Like some physicians at Fred Hutch, he works in HIV and cancer immunotherapy in parallel, applying lessons learned in one to the other.

“What’s the linkage between HIV and cancer?” said June. “There’s common ground, which is the immune system. … The immune system touches everything in our body.”

At the Fred Hutch-based defeatHIV, Dr. Keith Jerome, an expert in viral infections, and Dr. Hans-Peter Kiem, a stem cell transplant researcher, are investigating an approach that is similar to June’s, but instead of modifying just T cells, they are focusing on hematopoietic stem cells — the precursors that generate all the specialized cells of the blood and immune systems.

“Don’t give up hope,” said Brown, whose cure inspired the scientists and who has essentially given his life over to both advocating and volunteering for research. “This gave me purpose in life. I think there will be a cure.”

Others interviewed ended on equally hopeful notes, whether in finding an eventual cure, more equitably distributed treatment or a preventive vaccine.

“I grew up without AIDS,” said Fred Hutch’s Corey. “I’ve got four granddaughters and now a grandson. I want them to grow up without AIDS.”

 “Look, don’t stop now,” said Bush. “We’ve come too far.”

Have you watched Countdown to Zero yet? What did you think? Tell us on Facebook.


Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.

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