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The Climb!

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Ever heard of the Chinese phrase, “Outside of this mountain that you’ve marveled at or climbed, there’s a taller one waiting for you somewhere”? If you have, then you can most certainly relate to this blog post. That saying seems to be resonating through me as I write this blog entry. It makes me think about the different objectives that we pursue, not just in research but also life: it’s almost like life is this never-ending hike, with hill after hill after hill that we need to climb if we want to reach the top of the final mountain. Just like Miley Cyrus says in her song, The Climb. “There’s always gonna be another mountain, I’m always gonna want to make it move. Always gonna be an uphill battle, sometimes I’m going to have to lose, it’s not about how fast I get there, it’s not about what’s waiting on the other side, it’s the climb”.

Personally, the past few weeks have been filled with incredible triumphs (see my previous blog). I’ve just conquered the peak of data collection and analysis for my MSc. Unfortunately, there isn’t time to relax and bask in my glory and I’m sitting in the shadow of another looming mountain.  That latest mountain is reporting, discussing, concluding and formatting my dissertation.

Few scientists choose this career because they like writing and communicating…. and I guess that makes me a typical scientist. I have been somewhat struggling with writing up my dissertation. I do believe that the brisk pace that I have been working at might just have an effect on that struggle.

Being the perfectionist that I am, I feel like there is a need to make amends for not submitting my dissertation last year. One way of doing that was to work on my document and submit it as soon as possible. That’s all well and good, but I reckon that one thing that I did not consider was that writing up in a hurry would affect the quality of my work. “It’s not about how fast I get there, it’s not about what’s waiting on the other side, it’s the climb.” So it means the process of writing up is more important than just submitting.

You’d think that after years of listening to those lines, they would actually mean something to me by now!

Only after many attempts to submit my chapters to my supervisor and getting them back with lots of unpleasant red ink, have I finally decided to slow down, to pause and think about what I want to do before doing it. Because when I keep rushing rushing rushing to just put something – anything – on paper for her, I lose sight of my real goal; I’m getting somewhat lost. And I don’t want to keep wandering aimlessly, after all.

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Just had a flashback of a book called “Think Fast and Slow” by Daniel Kahneman that I bought a few months back. I haven’t finished it by the way, but I’ve read enough of it to grasp the concepts echoing through the book. Sometimes you have to make fast and instinctive decisions and, sometimes, you have to be reflective and more deliberative in your approach. The dark tunnel phase of my research has passed, the phase where had to move fast and instinctively. Now I need to slow down and be more purposeful in my approach, I need to read the results, be one with them and discuss them as they are.

Easier said than done though, right? Like I said in my earlier blog, not a lot of work has been done on Moringa oleifera seeds and egg laying chickens. This too is a mountain that I have to move. I guess it’s called “Masters” for a reason. It’s not about just feeding chickens and getting eggs but also about the scientific consequences of that. Because no matter how solid your research may be, if you don’t publish it, don’t grapple with the methods and conclusions yourself, then it’s as good as never having being done. In the scientific world, it doesn’t exist.

I’m a little bit of a twitter fan, so whilst I was there, minding other people’s business, I saw a post shared by one of my fellow student, Nobuhle Sharon Lungu. The post said, “We Screenshot_2016-06-03-20-16-19win every day but we don’t appreciate, we only celebrate when we win big”.

I hope this blog will change this mindset; you must celebrate every victory, every small mountain top that you reach. I had to take joy in finishing data collection, or else I would not have had energy for this current slog. So, yes, every peak you reach, celebrate it — even if you think it’s not too high; because it is those small hills that make us stronger to fight and reach the ultimate peak.

Posted on by ScientistSim · 1 Comment

Exciting times for HIV vaccines, less exciting times for the virus

On International HIV Vaccine Awareness Day (the 18th May 2016) at the HIV Vaccine Trial Networks (HVTN) meeting, it was announced that for the first time in 7 years and the first time in Africa, a HIV phase 3 vaccine trial will be taking place. In addition to this the world’s first HIV antibody infusion trial started with its first South African participant in Soweto.

Slowly we seem to be completing a puzzle. Perhaps the most complicated one ever pieced together.

Science is a developing story. Every study, no matter how mundane, adds a puzzle piece to the picture. Sometimes it’s an edge piece, that forms the basis for studies to come and sometimes it’s a middle piece that doesn’t really help anyone at the time but will be imperative to complete the picture. In some cases though, in order to progress, scientists stop fitting in pieces to the main puzzle and start their own. This is a risk because the evidence is leading the field in a particular direction and this direction is fairly certain because multiple people have determined the same thing. Sometimes though, the risk of deviating is worth it. Risk shakes up the field; breaks down dogma and enforces flexibility. And that is what this trial could mean for HIV vaccinology.

I am beyond excited that we are having our first trial in seven years and I’m even more excited that it is happening in South Africa. Capacity building has happened over the last couple of years, allowing for South African clinicians and scientists to run these trials. This means much more opportunity for young scientists, collaborations, funding and all round focus. We are finally in the spotlight. The findings of trials always mean that interest in the field surges again. New ideas will be emerging from unexpected places.

The most recent vaccine trial regimen that showed any protection was the U.S. Military HIV Research Program-led RV144 clinical trial in Thailand completed in 2009. This regimen showed that protection was mediated by something we did not expect. All our data in the field up until that time suggested that antibodies (called broadly cross neutralizing antibodies) that could bind and coat lots of different HIV viruses (preventing entry into cells) would be our best shot at a vaccine. But protection (bear in mind it was only 31%) was achieved by antibodies that weren’t able to block infection of a cell. Instead they are able to bind to an already infected cell and call for backup. Other cells with the ability to secrete substances that pop the infected cell heed the call and come to destroy the infected. Think of the broadly cross-neutralizing antibody as Batman (pretty capable

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of a fight on his own) and these other antibodies as Robin. The vaccine was tested in Thai people who have a very different epidemic to the part of the world that bears the greatest burden, Southern Africa. So the HVTN has run a series of small trials in South Africans using a vaccine that would be more appropriate for our situation. And now, we are paving the way to HVTN 702 (not to be confused with the talk radio station); the phase 3 trial guaranteed to rock the boat of science.

 

A phase 3 trial is a big deal. A wide range of criteria need to be fulfilled in order to proceed to one and the criteria that were set for HVTN 702 have all been met. However there is much talk in the field that we are progressing for progress’s sake. Many feel like we are creating a vaccine that has both arms tied behind its back and we are expecting it to win an arm wrestling contest. We are expecting robin to win Batman’s fight.  We are pushing a vaccine through that does not create the antibodies we know are going to protect people and are based on historically unimpressive antibodies. Should we be doing trials on things we know are not optimal or should we take the risk and acknowledge that there are clearly things we do not understand? Perhaps what now seems like an arbitrary puzzle piece will start off a new and exciting puzzle.

hero sidekick5400 South Africans will be enrolled from November 2016 and we will know the outcome by 2020. It’s a long time to spend on something that may not work again. What would going back to the drawing board mean for new infections? The bottom line is we have not yet managed to summon Batman to fight for our cause. We have lots of ideas on how to get him there but so far nothing has worked. Should we give up on Robin just because he is not what we expected?

Most vaccines have taken between 25-50 years to develop, so technically 30 years in, we aren’t doing too badly: we have drugs that are very effective at keeping AIDS patients well, which our government has now pledged to provide free of charge to everyone infected; we have drugs that can be used to prevent infection (pre-exposure prophylaxis) and we have lots of ideas bout what will protect people in a vaccine setting.

For me, the proof will be in the pudding. By 2020 we may have even brighter ideas about what we need and how to get there. And potentially the pessimistic view of the current phase 3 if irrelevant if it goes on to form new dogma. If all this phase 3 trial does is encourage bright and motivated young people to tackle arguably one of the most perplexing problems the world has, it will be a win. Either way, now is not a good time to be HIV.