I’ve recently had several people ask me if I thought there were similarities between the COVID-19 pandemic and HIV. The only similarity I see between the two viruses is that they use RNA vs DNA as their genetic material. What that means is, a virus enters the body and latches on to a protein on the surface of a host cell. It then enters the cell releasing its RNA to replicate itself to move on to the next cell and the next cell and so on until it is stopped by medication, vaccine or one’s own immune system. The fact that HIV was an RNA virus gave way to the expansion of more RNA antiviral drugs that will help treat the COVID-19 pandemic.
To date, we do not have an FDA approved treatment for COVID-19 although there are some 70 drug therapies out there in clinical trials. Developing new miracle drugs is time-consuming and expensive. As a result, there are approved drugs for other illnesses that can be repurposed to treat COVID-19 by way of a “Compassionate Use” request to the FDA by a physician. One of these antiviral drugs is Remdesivir which was originally developed to treat Ebola. This is the drug that was successfully used to treat the first known case of COVID-19 in the state of Washington.
The second drug that is gaining attention is chloroquine and more explicitly the less toxic derivative hydroxie-chloroquine in combination with the antibiotic Zithromax (Z-pack). Chloroquine is an approved drug to treat malaria and autoimmune disease, specifically lupus. Although hydroxie-chlorolquine and Remdesivir target different ways to block the replication of the virus they have both shown promise in lab dishes, animal models and clinical trials. There is also research in another class of drugs called “protease inhibitors” that were approved to treat SARS and HIV.
As of now the quickest way to help COVID-19 infected people is to repurpose FDA approved drugs. Future treatments will take time and will address different ways to block the pathway of the virus. Scientists are trying to identify the exact protein on the outside of the cell that the virus attaches to. This discovery will allow them to find small molecules that will block the virus from attaching to the cell wall. There is also the possibility of using a cocktail of drugs which is the most effective treatment for HIV.
Beyond drug therapy, there are also efforts to develop an antibody as a temporary treatment on the way to a vaccine. When the human body is exposed to a pathogen like the COVID-19 virus, it alerts the immune system to create an antibody against the pathogen. The next time the body is exposed to the same pathogen the immune system activates those antibodies to attack and remove the invader. Using this logic, Johns Hopkins is using the antibodies from blood plasma or serum of people who have recovered from COVID-19 to boost the immunity of newly infected people. This medical concept is known as “convalescent plasma” dating back to the early 20th century to counter the epidemics of mumps and measles. This is looked at as a temporary measure and not a solution to treating COVID-19 which will be a vaccine.
Vaccines have a history that started in the late 18th century by Dr. Edward Jenner. He was trying to treat smallpox when he learned that milkmaids were immune to the disease because they had already been infected with cowpox. He took the pus from the hand of a milkmaid and scratched it into the arm of a boy infected with smallpox. Six weeks later he injected the boy with smallpox observing he was now immune to the disease and did not get sick. Dr. Louis Pasteur followed the same theory to develop rabies and other vaccines. He coined the term vaccine in honor of Dr. Edward Jenner because of the way he treated cowpox which was known as vaccinia.
Historically, vaccine trials come in 3 phases. Phase I usually lasts about 6 months to show the vaccine is safe. Phase II lasts about a year to establish that the vaccine creates an immune response. Phase III takes 3 years or more to track the effectiveness of the vaccine for people exposed to the infection.
The United States is on the fast track to creating a COVID-19 vaccine. The FDA is allowing scientists to combine phases I and II while also cautioning that speeding through the process too fast might lead to a bad vaccine. Some of the pitfalls of a bad vaccine are serious side effects, not providing a lasting immunity either because of the human immune system or the COVID-19 virus may mutate. The good news is Chinese researchers have already cracked the virus’ genetic code and we should see a vaccine in 12 to 18 months when normally it would take 10 or more years and billions of dollars to develop.