By The Guardian
LONDON – As a child, Kundai Chinyenze wanted to become a chemical engineer. Her mother, a nurse, said she should train as a doctor.
Chinyenze disagreed, until one day, when she was 16, her mother was admitted to hospital in Harare, the capital of Zimbabwe. When Chinyenze went to visit, she heard nurses whispering behind her: “That’s the daughter of the woman with Aids.”
It was the first time Chinyenze, now 44, knew her mother had been infected with HIV.
“I was gutted,” she remembers. “All I knew was, you get it, you’re dead. I didn’t understand much else beyond that.”
She waited for the doctor to do his evening rounds so she could find out more. “He was so cold and dismissive. He said, ‘We don’t talk about such things to children’, and he walked off. I was hurt and angry.
“I remember crying, looking at my mum’s bed and thinking, ‘I’m going to become a doctor and I’m going to learn everything I can about HIV.’”
Today, Chinyenze leads a global team working to create an HIV vaccine, 21 years after she helped open the first HIV clinic in Zimbabwe.
Her mother died soon after that hospital admission, and two years later, her father died of Aids. By that time she was at medical school and could recognise the symptoms.
Those were dark days. There was no treatment. The minute you had that diagnosis, it was a death sentence.
In 2002, when she joined the team to open the HIV clinic, antiretroviral drugs, which work by stopping the virus replicating in the body, were not available in Zimbabwe. Every day, hundreds of patients would form a snaking queue outside the clinic, remembers Chinyenze. “Those were dark days. It was disheartening. There were a lot of deaths and no treatment. The minute you had that diagnosis, it was a death sentence.”
Hospitals were full of HIV patients who were emaciated after losing so much weight and dehydrated after months of chronic diarrhoea. Faced with such a grim situation, and feeling powerless to help, Chinyenze began researching HIV prevention, which led to her work on the vaccine. She is now based at the International Aids Vaccine Initiative (Iavi) human immunology laboratory within the Chelsea and Westminster hospital in London.
The work is challenging and full of disappointments. The structure of the HIV virus is complicated. A few patients have been “cured” but only after a complex intervention. “The body itself does not know how to recover from HIV,” says Chinyenze. “Because you don’t have a human model of recovery, you’re trying to teach the body something it hasn’t figured out how to do naturally.”
Three recent trials in Africa and the US have failed, which means scientists have had to go back to the beginning.
What keeps Chinyenze and her team motivated is the knowledge that, despite all the advancements in HIV prevention, there is still an epidemic with new HIV infections, and people dying every day. “To control the epidemic, we need a vaccine. That’s what keeps us going,” she says.
Work currently centres around broadly neutralising antibodies (bNAbs), which experts believe are likely to offer protection. They are trying to figure out the components that would induce the body to produce these kinds of antibodies. A trial last year was successful in showing that it is possible to induce immune responses against the HIV virus. When the Guardian visited the lab, work was under way to begin pre-clinical testing of a vaccine candidate.
It’s critical to remove HIV research from being a preserve of developed nations which don’t necessarily live the reality.
There is a still a long way to go, admits Chinyenze, but she is determined that African scientists play a bigger role in the work. “It is so critical that we remove HIV research from being a preserve of developed nations who don’t necessarily live the reality, or see it in their context, and bring in scientists and communities in affected areas who understand the urgency,” she says.
“If you make a vaccine that will be delivered at -80C and you’re already struggling with finding 2-8C for childhood vaccinations, you’re thinking, ‘This is not going to work.’ It’s those simple but critical things that mean you need to involve the scientists from the places that are affected.”
Chinyeze leads a programme called Advance, primarily funded by USAid, that is building capacity in Kenya, Rwanda, Uganda, Zambia and South Africa.
She admits it was frustrating to see the speed of developing a Covid vaccine compared with the glacial pace on HIV. “It is [frustrating] looking back, wishing that we were working faster, and fewer people would be dying in the meantime. Fewer people would be becoming infected. I do think about that,” says Chinyenze.
“If there’s anything we’ve learned, [it’s that] we are faster, and get to solutions faster, when we remove barriers. Science can never be in a vacuum. [We need] scientists to challenge, and feed off each other to come up with the best solutions and find answers to our problems.”