Submitted by ShelfordPrefect t3_10kye24 in askscience
FelisCantabrigiensis t1_j5txe0b wrote
HIV is like a rootkit on the software of your immune system: it destroys the very cells that would be sent to destroy it. That's why it's so hard to vaccinate against. Fortunately, we have very effective treatments to suppress it and we can, if we deploy these widely enough, expect to suppress it out of transmission in the foreseeable future. HIV isn't very easy to transmit so if you suppress it in the people who have it, it should die out when the oldest person with HIV dies of other causes, after spending their life with suppressed HIV.
Herpes is a sneaky bastard that hides out in nerve cells, out of the way of the immune system. The immune system can deal with it if it can find it, so that's why it hides.
Note that the work to be able to create a Covid vaccine has been in progress for decades. BioNTech (the actual inventors of the "Pfizer Covid vaccine") was founded 15 years ago and the more fundamental research on mRNA vaccines was done before the company was founded.
A huge amount of this understanding of viruses comes from the ability to sequence genomes. This is almost magical - it really is science fiction come to life. It's as magical as the "Star Trek communicator" becoming "cellphone in your pocket, works worldwide". The Human Genome Project required rooms full of thousands of expensive machines working for several years to sequence one genome. Today, you can do a full sequence of a human-size genome in less than a day (current record: 5 hours 22 minutes!). You can grab a random virus or bacterium and sequence it overnight, just to see what's interesting in its genome. If you find another one tomorrow, you can compare them over the weekend. This is a huge change for all life sciences.
It was sheer luck that mRNA technology was almost advanced enough to make vaccines for coronaviruses when SARS-CoV-2 (the virus that causes COVID-19) showed up. A lot of researchers worked a lot of overtime to turn "almost" into "actual" in an amazingly short time.
We also have a lot of experience making vaccines to viruses that the immune system can handle when suitably primed (i.e. NOT retroviruses like HIV, but most others) in other ways - using similar virus strains, culturing viruses and inactivating them, weakened live viruses, and so on. These methods had been used to produce vaccines for the SARS virus (the vaccines were not widely tested because by the time they were ready, there were too few cases to test and no need for them). The same techniques were also used to produce SARS-CoV-2 vaccines.
We can expect a lot more vaccines for diseases previously considered impossible to vaccinate against, using mRNA technology.
Aside from mRNA tech, research continues on other diseases. RSV (Respiratory syncitial virus) is a serious disease for infants, but attempts to make vaccines were disastrous in the past and the reason why the first attempts failed has only recently been understood after 30 years of work. This work doesn't even use mRNA knowledge, it's completely separate innovation.
Virology and immunology are both extremely complex topics which we have, across the world, not nearly mastered. We do not understand either, not even nearly, so the rate of advance of knowledge is rapid in both. When they intersect, they are both even more complicated. You have to see the current state of vaccines as a work in progress, where some problems have been solved and others have not, depending on random chance and whatever seems most important at the time.
I'm nearly 50 years old. In my lifetime, we have gone from commonplace vaccines for only a few things - polio, etc - to vaccines for a whole array of nasty diseases (measles, mumps, rubella, diptheria, typhoid, tetanus, pertussis, pneumococcus, influenza (moving target, alas), etc).
I expect in 50 more years, we'll have zapped most of them.
quats5 t1_j5v4x5s wrote
I remember looking around about a decade ago and realizing that I hadn’t heard about chickenpox in a while.
I had a very light case when I was so young that I don’t remember it, so I’ve always known my immunity is likely negligible and that I need to be wary and stay clear of people who have it. It’s much more dangerous in adults.
….and then I realized I hadn’t had a mental alert of caution! Caution! Chickenpox! in… years.
So I Google and… oh. They made a vaccine for it in the 90’s, and it’s standard now. And practically nobody gets chickenpox any more because of this.
Nice.
farrenkm t1_j5w9k8d wrote
I started working for a local hospital system around the turn of the century. They asked if I was up-to-date on my vaccines, and I said yes. Brought in the hep B documentation and everything.
Then they asked: have you ever had chicken pox? Dunno. Not that I'm aware of. They drew a titre and -- nope, no antibodies. They gave me the vaccine late 20's, early 30's. My next question, that I'll ask my MD, is if I need to worry about shingles. If I never had chicken pox, if I had the vaccine, should that be protection enough so I don't need to worry about it? My first reaction is "yes, that's true."
NatAttack3000 t1_j5wdaph wrote
I had the chickenpox vaccine at about 24 and got chickenpox at 31, so you definitely still have a risk of getting chicken pox and possibly shingles though far less than if you didn't get vaccinated
auraseer t1_j5z4nq1 wrote
CDC still recommends you get the shingles vaccine when you turn 50. We don't yet have proof that the chicken pox vaccine protects for your whole lifespan. It hasn't been around long enough to be sure, and we know that some kinds of immunity wane as the years pass.
farrenkm t1_j6153ue wrote
Thanks for the response. Getting the vaccine doesn't bother me, I just didn't know if it was still a concern without having had chicken pox proper. That age isn't far off, so it's information I'll need.
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mradenovirus t1_j5v4cwo wrote
Rabies is an extremely slow virus. You can actually get bit and then go get the vaccine and be saved. That’s part of the reason we can be vaccinated for it. A primed immune system can still have time to react and clear
ommnian t1_j5vynbe wrote
Yes, but also, when you're given the rabies vaccine in these cases, aren't *just* getting the rabies vaccine. You are also getting Rabies Immunoglobin. Which works alongside the vaccine to prevent the rabies virus from infecting you.
zebediah49 t1_j5x3s5u wrote
You probably don't actually need that.
But when the alternative is certain death, it's worth going the extra mile with the immunoglobin, just in case...
(Also, I certainly don't want to be part of the controlled trial to determine how necessary it is)
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FelisCantabrigiensis t1_j5v8436 wrote
That's true, and very unusual among viruses.
You can also be pre-emptively vaccinated for it, and then it works well too.
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saganmypants t1_j5wb1ov wrote
Amazingly, of the 14 vaccines routinely administered to babies today 8 of them were developed through the work of little known Maurice Hilleman and his team
SkiNinja82 t1_j5x1otn wrote
woah that guy was awsome! i did micro as my undergrad with a small toe dipped into immunology but never heard of him during my studies!
No-Turnips t1_j5wdzdz wrote
IF we all keep getting vaccinated. There are previously eradicated viruses making a resurgence in younger populations because of anti-vaxxing. Eradication depends on us ALL continuing to vaccinate.
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layzeeviking t1_j5y3ctf wrote
Expecting everyone to cooperate is an authoritarian pipe dream, and even then, there's all the viruses that also infect other animals (like sars-cov-2). We can live in a sterile box, or accept a certain risk.
Suspicious_Ad_4768 t1_j5uof5a wrote
So herpes hides in the nerve cells. So does Rabies, but how do we have a vaccine for Rabies?
FelisCantabrigiensis t1_j5uq5rq wrote
I haven't kept up with the exact differences, but I will say that rabies is 100% deadly and herpes is 0% deadly, which may affect the amount of effort put into this.
Rabies also does not hide out in nerves. It travels along nerves to the brain, but it doesn't hide there in a mostly-inactive state for a long time. It vigorously infects nerves and travels along them, which makes it more vulnerable to immune cells and also triggers more response from immune cells.
dbx999 t1_j5xmcnr wrote
When a virus occupies the nerve cells and the brain, it’s like occupying an immune-free zone. The technical term I believe is immune privileged sites. These areas do not have immune system activity. This is probably why these viruses have adapted to occupy these sites.
FelisCantabrigiensis t1_j5yqcpv wrote
Correct. Not least because immune activity killing off nerve and brain cells is a serious problem because they regrow slowly or never, so the compromise is that the immune system does not touch irreplaceable cells and aims to kill viruses and bacteria before they can reach those cells.
dbx999 t1_j5yqww6 wrote
Worrisome that Covid is found in various areas including immune privileged sites as this indicates full recovery from the infection may not occur
PerpetuallyLurking t1_j5uv6pk wrote
Yeah, the fact that no one dies OF herpes has a lot to do with the impetus to find a vaccine vs everyone who gets rabies dies. And even then HPV is related to herpes, can lead to cancer, and now has a vaccine. So…wait patiently, probably. They’re working on the deadly ones first, not the annoying ones that do have a reasonably easy treatment.
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SofaKingI t1_j5wa8kr wrote
Keep in mind that "hides" is a massive oversimplification.
Anyway, I don't think Rabies "hides" in the same sense as herpes. It doesn't lay dormant in your nerve cells for years until the next chance to cause an outbreak. It just infects nerve cells.
Kenlaboss t1_j5w5git wrote
We truly live in the beginning of the modern era, and it's fantastic in a way to see history unfold before us.
eazy_64 t1_j5wv9ms wrote
Nanotechnology as well. Wait until you hear about nanoscale microbots that can evade your immune response and deliver therapy or target specific cells.
hollyjazzy t1_j5x71au wrote
Thank you for this beautiful explanation.I certainly hope your prediction at the end is correct, and that the anti vaxxers do not derail it. I remember when smallpox was declared extinct, it felt miraculous that such a deadly disease for centuries was no more. So many more diseases were on the cusp of being eradicated until distrust of vaccination started increasing immmensely in the early years of this century.
mancapturescolour t1_j5xn7bv wrote
> Fortunately, we have very effective treatments to suppress it and we can, if we deploy these widely enough, expect to suppress it out of transmission in the foreseeable future. HIV isn't very easy to transmit so if you suppress it in the people who have it, it should die out when the oldest person with HIV dies of other causes, after spending their life with suppressed HIV.
Yes, it's effective and cheaper than ever.
> If properly adhered to, ARV treatment, which costs as little as 20 cents a day, not only keeps an HIV-positive person alive and healthy, but also reduces the risk of transmission.
Source: https://www.red.org/our-impact-areas/#testing-and-treatment
Now the game-changer in all this, for me, is that supressing HIV during pregnancy prevents mother-to-child transmission of the virus. That means a child to a HIV+ parent can be HIV free at birth! So, we don't have to wait for HIV to die out with old age, there are people already born HIV- thanks to these drugs. The United States have made a significant impact through PEPFAR in the last 20 years (this Saturday!) but we rarely hear about that success story.
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mancapturescolour t1_j5z0ck9 wrote
Thank you, that is very important to point out. I appreciate your insights, it's so valuable to share.
It's a multifaceted issue and what you state, adherence, is a key point indeed: Undetectable = Untransmittable aka (U=U). For that to happen people that need these ARVs must have access, and be comfortable to take them regularly for a long time.
We're not there yet but I believe we will have the means to turn this epidemic around completely. Whether by vaccines, replacing stigma by normalization of what life with HIV is today, or arriving at an HIV free generation...as long as there's a will, there's a way. Just the idea that you can lead a "healthy" and normal life with HIV today is so mind-blowing compared to how it was only a few decades ago.
smash8890 t1_j5x45yk wrote
Why did the RSV vaccine fail?
MazerRakam t1_j5xj36h wrote
Combination of a lot of factors, vaccine research was still fairly new and virology wasn't nearly as well understood as it is now. They were targeting the wrong proteins and getting frustrated that they weren't getting the results they expected. Come to find out, RSV actually changes shape (protein unfolding) after it enters the cell. This is important because antibodies can only prevent a cell from getting infected, antibodies cannot enter a cell and push the virus out. So researchers were taking infected cells, analyzing the virus in those cells (after it changed shape) and tried to make a vaccine that would teach the immune system target those structures. But those structures weren't found outside the cell, and the immune response was hindered because of that.
Luckily, someone figured that out, and they redirected their focus and were able to create a vaccine that teaches the immune system to target the virus structure before it enters the cell and now RSV vaccines actually work the way they should.
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blp9 t1_j5uhmq0 wrote
>(also during all years of mrna development it was never tested on humans)
This is a table with at least a dozen completed human clinical studies for mRNA cancer treatments prior to 2017.
While this is a table of mRNA infectious disease trials, with at least 3 of them completed. Also all prior to 2017.
This is from a journal article published in 2018.
LSeww t1_j5untbx wrote
Most of them are I/II phases studies (dozens to low hundred participants), only two at phase III, of which one is terminated (no desirable effects) another is expected to end in 2023. A decent amount of them were not even completed in 2019. So no, nothing was tested on humans at the time they decided to use if for covid. "Tested" means completed phase 3.
blp9 t1_j5uv2dz wrote
That is a much better point than "it was never tested on humans".
Is your position that the Pfizer and Moderna Phase 3 trials were flawed in some way and therefore don't count?
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