It has been 30 years since Dr. Robert Gallo became internationally famous for his role in the discovery of the virus that causes acquired immune deficiency syndrome. He has wrestled with the question of a cure countless times since then. But only within the last year, he says, did he conclude that working toward a "functional cure" makes the most sense.
AIDS has killed more than 36 million people around the world since the early 1980s. A similar number of people are infected with the human immunodeficiency virus that Gallo and French scientists co-discovered. Treatments, including some developed by Gallo, have improved; HIV-infected people in North America can live into their 60s, even 70s.
But a full cure remains elusive.
"I've been off and on about [a cure] almost constantly since therapy became available," says Gallo, the director of the Institute of Human Virology, which he co-founded at the University of Maryland School of Medicine in 1996. "You think about it. You put pen to paper, and I've had several meetings with select scientists in our institute where it's talked about.
"And then, I guess, within the last year, I said, 'We've got to get realistic.' Functional cure, I believe, is definitely achievable."
Because he gets the question all the time, Gallo carefully makes the distinction between a cure and a functional cure.
"If you say to me a virological cure — no virus left, no viral gene left in the body — this is extremely difficult. There are two reported cases in the world right now and, honestly, it's not even possible to conclude in those cases, although it's likely.
"We have seen, for example, in animals where we think there is no more virus, and then in a postmortem you find some viral genes and some virus particles in the lymph nodes, in the gastrointestinal tract. ... So if you say to me, in the next 10 years, do I see a common approach for a total virus cure, so that there's no more virus, absolutely none left — and we strongly believe that — and it's available for the world, I would say I don't think that is going to happen. ...
"Now how about functional cure, where the person lives a completely normal life span? Even in the best-treated people today there's some evidence for an increased incidence of some cancers like lymphoma. Let's say we get rid of all those increased frequencies. And [patients] don't ever have to take the medicine again. Is that achievable? And the answer to that is: I think so. If you say, 'Put a date on it,' I can't. But you can see real possibilities because some of the drugs available now, and some that are just coming out, are truly, amazingly more efficient."
Gallo says antiretroviral therapies, combined with other approaches emerging in HIV research centers around the world, can provide the functional cure for AIDS. In such a cure, he says, HIV is "really totally suppressed" and an infected person no longer needs therapy.
That's achievable, Gallo says.
"You know," he laughs, "you only have one life to live for your country, and you've got to put your time and effort where you think you can make a difference, and I think this is the way to go."
Gallo is 76. If he were younger and funds for research were available, he might plug away at achieving the cure. "If you're 25 or 30 instead of my age and that's what you want to work on, I don't discourage it," Gallo says. "But I don't think it's going to come in any near future."
Ironically, that young researcher Gallo imagines might not even exist. It's one of his big concerns — a lack of successors to the medical scientists of his generation, those who arrived at the National Institutes of Health in the mid-1960s to conduct important research with the full backing of the U.S. government. Few medical students at Maryland now seem interested in studying viruses, he says.
"I don't see the same awe many of us [at NIH] had when we said, 'My God, we're able to ask questions related to solving problems of human life.' I think that has definitely declined. I have a particular concern about medical virologists — people who are expert in viruses, young people coming into the field. That's definitely on the decline globally."
That's one of the reasons Gallo helped establish the Global Virus Network in 2011 — to promote international cooperation among virologists, rapid response to new or emerging viruses and the training of the next generation.
Given the deadly potentialities, there's no room for a lapse in expertise anywhere on the planet. But too often, Gallo says, humans have forgotten the lessons of the past. He eagerly recites a history of outbreaks suggesting that our collective memory span — and commitment to unbroken vigilance — is only about 30 years.
That's not long enough, Gallo says, so he stays on the job, with no plans for retirement.
Dan Rodricks' column appears each Tuesday, Thursday and Sunday. He is the host of "Midday" on WYPR-FM.