Part one of a three-part series. Read more here.

One patient changed James Curran’s career in medicine.

While working as an epidemiologist for the Centers for Disease Control and Prevention, Curran was asked in 1981 to examine a New York man suffering from a rare skin disease. It soon became clear that an entirely different virus was weakening the patient.

That patient was one of the first to be recognized as a victim of what soon became known as AIDS.

More than two decades after the initial discovery of the virus, HIV/AIDS has blazed through developing and developed worlds alike, earning a title as one of the planet’s most lethal diseases. The CDC reports that about 40,000 Americans become infected with the disease every year. In 2005 alone, 2.8 million people around the world died from HIV/AIDS.

The war on AIDS has been fought on at least two major fronts: treating those who currently have the disease and preventing others from ever contracting HIV.

Curran, the current dean of the Rollins School of Public Health, has been spearheading AIDS research at Emory since 1995. In 1997, the Rollins school, the School of Medicine, and the Yerkes National Primate Research Center pooled resources to form Emory’s Center for AIDS Research, one of about 20 federally funded centers in the country trying to cure AIDS. Since its inception, total funding for AIDS research at Emory has increased from $23 million in 1996 to $59 million in 2005, with 163 studies currently underway.

Emory’s efforts against AIDS run the gamut from vaccine research at Yerkes to human testing at the Hope Clinic to drug discovery in University laboratories.

The University made headlines for its research efforts on the first front of the HIV war — treating current patients — when it sold the rights to a powerful treatment drug in 2005. The drug, called Emtriva, has led to the development of a new medicine that allows HIV patients to drastically reduce the number of pills they must take each day to stay alive, and research efforts like those that led to Emtriva’s development continue at Emory.

But another group of Emory scientists have been pursuing what some consider the holy grail of AIDS research, a vaccine against HIV itself.

Emory’s Vaccine

Because a virus is not technically alive, it cannot be killed by using weapons like antibiotics, and because it proliferates throughout a person’s entire body, it cannot be destroyed by radiation like a cancer. The best solution, scientists agree, is to somehow trigger the human immune system to recognize the invading virus and prevent it from taking hold.

But ever since its discovery in 1981, HIV has eluded researchers intent on developing a vaccine. HIV mutates easily and frequently, which creates a moving target for scientists, who must pin down some facsimile of it to create a vaccine that will teach the body to recognize the virus.

Many attempts to develop a conventional vaccine against HIV have looked promising at the beginning, only to prove futile or even potentially harmful once research got underway. Today, researchers at Emory are looking to succeed where others have failed by pioneering an innovative technique to create a vaccine.

Traditional approaches to vaccine production, such as using a weakened version of the original virus or an inactivated virus, have failed, as have efforts to use recombinant proteins.

Harriet Robinson, chief of the division of microbiology and immunology at Yerkes, is trying a different tactic as she leads the effort to develop a new vaccine at Emory.

Robinson’s vaccine consists of two parts. The first component utilizes DNA to initiate an immune response in the vaccinated individual. The second step uses an MVA virus, a genetically modified smallpox virus, to further increase the immune response several weeks after the initial priming event.

Together, these two steps increase the number of white blood cells in a vaccinated individual’s body. These cells can then remember the virus and recognize it if that person is ever exposed to HIV. Robinson and her collaborators have already tested their vaccine successfully and safely in monkeys. Now they are in human clinical trials to test both the safety and the efficacy of the vaccine.

“If anyone can do it, it’s Harriet,” said chemistry professor Dennis Liotta, one of the developers of Emtriva. “She is absolutely driven to find a vaccine. She puts all her heart and soul into this. She is tirelessly pursuing this. I put my money on Harriet anytime.”

Dealing With the Here and Now

While Robinson and her team pursue the elusive HIV vaccine, other scientists at Emory are continuing efforts to help those currently infected with the disease. Some of these efforts, like those of Liotta and his colleague professor Raymond Schinazi, are already well-established.

In 1984, Schinazi set up Emory’s first HIV lab downtown near Grady Memorial Hospital. After contributing to the creation of the first FDA-approved herpes drug, he shifted his research focus to AIDS following the discovery that the deadly disease was caused by HIV.

In 1993, Emory was recognized as a premier AIDS research institute and was one of just four recipients of federal funding from Veterans Affairs to fight the pending epidemic, the Research Center on AIDS and HIV Infection (RCAHI).

Schinazi was named scientific director of the center and moved his research lab to the VA Medical Center on Clairmont Road.

Liotta and Schinazi’s partnership has already borne fruit. The combination of expertise in chemistry and virology resulted in the discovery of Emtriva, a small molecule used to treat HIV. The technology was sold in 2005 to Gilead Sciences, Inc. and Royalty Pharma for $540 million in the largest intellectual property sale by an academic institution in history.

The AIDS drug that was developed using Emtriva is now taken by more than half of HIV-infected individuals world-wide.

Most of the money has been reinvested into research here at Emory and 40 percent of it was split between the three Emory inventors.

Having years of experience working on the virus, Liotta explained that drugs alone will not be enough treat to treat AIDS and eradicate it.

“In sub-Saharan Africa, if we had every approved antiretroviral agent available free and in unlimited quantity, we still couldn’t solve this problem because the disease is very hard to manage,” he said. “We need good science, good education, and good social interventions.”

Because Liotta and many others involved in AIDS research at Emory say that a cross-discipline approach is necessary to eradicate the world of AIDS, Emory’s Center for AIDS Research (CFAR), first created in 1997, provides avenues for such dialogue to take place.

In the early 1990s when the RCAHI was formed, only 15 Emory researchers were members of the center. Now that new aspects of the disease like drug resistance have emerged and broadened interest in AIDS, there are over 120 investigators that comprise Emory’s CFAR.

“A lot of exciting things [are] going on… with an opportunity for future directions that we can’t even predict because we don’t know what synergies will come with bringing those people together,” he said.

— Contact Brett Israel and Kelly L. McCoy