Category: Department of Infectious Disease

World AIDS Day 2024: ‘Take the rights path’

Sarah Fidler and Jonas Bergmann Poulsen

To mark World AIDS Day, Professor Sarah Fidler from the Department of Infectious Disease, and student, Jonas Bergmann from the University of Amsterdam, reflect on the evolution of HIV treatment and the ongoing challenges. They discuss the impact of stigma, the importance of accessible medication, and the role of community-led initiatives in supporting those living with HIV. 

Professor Sarah Fidler

My first experience of HIV was in 1988 when I was 24 years old. I had just qualified as a junior doctor.  As I started work on the respiratory ward, there were several young people who were inpatients. This was unusual for an acute medical ward, which treats patients with urgent medical conditions. Our patients were a similar age to me, but these young people – who should have had their whole lives ahead of them were isolated, sick and dying.  

 Not only were they dying, but they were dying with a health condition that also affected their partners, all while  facing fear, judgement and stigmatisation. As a result, many had no family with them to help ease their passing – just prejudice, homophobia and ignorance. We had no medicines that could reverse the medical complications, nothing that could make them better. All we could do was to care for them as best we could, providing empathy, kindness and medical support to ease their journey.  

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How medicine and medical research has contributed to HIV stigma–and how we challenge it

Alan Winston

World AIDS Day is a vital opportunity to raise awareness about HIV/AIDS and honour those whose lives have been affected by the disease. Professor Alan Winston from the Department of Infectious Disease explores how language and scientific definitions have contributed to the stigmatisation of those living with the disease and emphasises the need for person-centred language and thoughtful scientific communication to reduce discrimination in medicine and medical research. 

The initial fear 

Since AIDS–Acquired Immune Deficiency Syndrome–was first identified in the 1980s, along with its underlying cause–the Human Immune Deficiency virus (HIV)– people living with HIV have encountered immense discrimination and stigma. Whilst this was partly driven by fear of the disease itself and the devastating clinical consequences of HIV without treatment, we should acknowledge that both physicians and scientists have contributed to this stigma. Here, I highlight how this has been mediated through language and scientific definitions. Although these contributors have likely not been intentional, going forward, we need to learn from past experiences and carefully consider how, as clinicians, clinical researchers and scientists, our work can focus on reducing the stigma and discrimination that has surrounded HIV for so many decades. 

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The complex relationship between viruses and our immune system

Prof John TregoningVirus Appreciation Day, celebrated annually on 3 October, serves a dual purpose: to foster respect and understanding for viruses while raising awareness about their serious impacts on health. To mark the day, Professor John Tregoning from Imperial’s Department of Infectious Disease shares valuable insights into influenza viruses, highlighting their effects, the importance of vaccination, and ongoing research for universal vaccines against evolving strains in our latest blog.

Viruses have an enormous impact on human health, but they don’t only infect humans. Many viruses also infect animals, plants and even bacteria. Some viruses are quite promiscuous, infecting a wide range of animal species before passing on to humans through a process known as zoonotic transmission. One of the most problematic of these zoonotic infections is influenza virus.  

The main natural reservoir of influenza virus is wild birds, particularly ducks and geese. The virus can then transmit from these birds into domestic poultry, like chickens, and to livestock, such as pigs, before ultimately reaching people. In the past five years, a new strain of avian influenza has emerged with an ability to infect an even wider range of mammalian species. It has been detected in cattle in the US.  

Influenza, the disease caused by the virus, poses a substantial health burden. It resulted in nearly 15,000 deaths in the UK in the 2022-23 winter season. As well as death, it is a significant cause of hospitalisation and general illness – with a long tail of recovery. Additionally, influenza infection doubles the risk of heart attacks and strokes for up to a year after illness. Given these risks, getting an influenza vaccine this time of year is highly recommended. As I discovered researching my latest book Live Forever one of the simplest ways of extending your life is through vaccination. A vaccine will give you protection against the most severe forms of disease caused by the virus and protect you against subsequent illness.Vaccines train your body to recognise pathogens and fight them off. To do this, they make use of a facet of immunity called immune memory. When re-exposed to the same virus, your immune response activates faster and stronger, stopping the infection in its tracks. Several aspects of immune memory can prevent subsequent infections, but an important one are antibodies – this is a type of protein that is highly specific in what it can recognise and bind. When you are immunised with influenza vaccine, you make influenza virus specific antibodies that can stop the virus from infecting you. 

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Celebrating Regius Professor David Holden’s profound impact on microbiology at Imperial and beyond

In this piece Professor Ramesh Wigneshweraraj pays tribute to Professor David Holden, who retired as Regius Professor of Infectious Disease this summer.  

Foreword from Professor Deborah Ashby, Dean of the Faculty of Medicine 

I am very grateful to Ramesh for penning this wonderful tribute to Professor David Holden, who retired in May having contributed so much to his field and our university. 

His Regius Professorship in infectious disease was announced on 6 June 2016, when the honour was granted by Queen Elizabeth II as part of her 90th birthday celebrations. It was Imperial’s second, and at the time was one of only 26 Regius Professorships to have been granted since the reign of Queen Victoria. It recognised the world-leading infection research at Imperial that David has been the epitome of.

I congratulate David on all that he has achieved and wish him all the very best in his retirement.

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Postcards from Kampala: Data and Dashboards in Uganda

Nina Zhu enjoying coffee and a chat with Dr Sanjeev Singh, CAMO-Net India lead
Nina Zhu enjoying coffee and a chat with Dr Sanjeev Singh, CAMO-Net India lead

The Centres for Antimicrobial Optimisation Network (CAMO-Net) recently convened an insightful meeting at Makerere University in Uganda. This international event brought together researchers dedicated to the critical challenge of antimicrobial resistance (AMR). Throughout the week, attendees engaged in a series of informative presentations exploring data-driven approaches to optimising antibiotic use. Hear first-hand from Dr Nina Zhu from the Department of Infectious Disease on what her experience at the event was like. 

I recently returned from Kampala, Uganda, where I spent an incredible week at Makerere University for the Centres for Antimicrobial Optimisation Network (CAMO-Net) event. Colleagues from around the world came together in Kampala to share knowledge, take part in workshops, and learn more about the work our Uganda National Hub does to address antimicrobial resistance (AMR) in Africa and beyond. 

Data and Dashboards for Optimising Antibiotic Use 

The event’s theme was ‘Data and Dashboards’. Harnessing the power of data through strategic and targeted studies to generate new knowledge related to optimising antimicrobial use is a key theme of CAMO-Net. As my work focuses on using data linkage and system dynamics modelling to understand healthcare-associated infections and AMR, it was a perfect week for me!  

I was joined in Kampala by CAMO-Net members from four other countries: Brazil, India, Malawi, and South Africa. We received such a warm welcome from our Ugandan hosts and started the week with a networking session at a local restaurant. At the reception, Dr Andrew Kambugu, CAMO-Net Uganda lead and head of Makerere’s Infectious Diseases Institute (IDI) gave a fascinating showcase of IDI’s history. It was a perfect blend of networking and getting to know more about the impressive strides IDI has made in infectious diseases, data, and AMR. 

Professor Umar Kakumba, the 1st Deputy Vice Chancellor of Makerere University, and Dr Andrew Kambugu, CAMO-Net Uganda lead, welcomed the whole CAMO-Net team

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St Mary’s Medical School: End of a chapter

Professor John Tregonning (front centre) in the early days of his career in the Department of Surgery and Cancer.

As the Faculty of Medicine prepares for the full decant of the St Mary’s Medical School Building, Professor John Tregoning, Professor in Vaccine Immunology in the Department of Infectious Disease, takes a trip down memory lane, reflecting on almost 20 years spent working in the “site steeped with history.”

On the 1st of August 2024, as part of a wider departmental move, I will leave the St Mary’s Hospital campus having worked there for nearly half my life. As such, it felt like time to reflect.

I first crossed the threshold when the St Mary’s medical school had just merged with Imperial in 1999, visiting friends who were studying there. Admittedly, it was not in an academic capacity. I went to the long-closed, but legendary bar in the basement (allegedly it closed because seeing future doctors heavily inebriated was off-putting to those visiting the hospital). I don’t remember much of that night, a fact I am putting down to time passed, rather than beers consumed.

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The one with a Nobel prize winner

Hadi Sallah, PhD student in John Tregoning's lab, working on RNA vaccines.
Hadi Sallah, PhD student in John Tregoning’s lab, working on RNA vaccines.

Dr John Tregoning, Professor in Vaccine Immunology, recounts his experience of working with Dr Katalin Karikó, Nobel Prize winner and the tenacious force behind the mRNA vaccines that helped change the course of the COVID-19 pandemic. Their recently published study investigates how RNA modifications impact the body’s immune response to infection, with the hopes of aiding the development of more effective mRNA vaccines.

Science is collaborative, we work with lots of different people to understand the world around us. Working with other people is one of the joys of the job. In our recently published study, Reducing cell intrinsic immunity to mRNA vaccine alters adaptive immune responses in mice, we had the privilege of working with Dr Katalin Karikó, joint winner of the 2023 Nobel prize in Physiology or Medicine.

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Why not eliminate HTLV-1 while eliminating HIV-1? We need HTLV-1 PEP/PrEP clinical trials.

Dr Goedele Maertens and Dr Fabiola Martin

HTLV-1 PrEP Open Letter to Gilead & ViiV 

Human T Lymphotropic/Leukaemia Virus-1 (HTLV-1) is a sexually transmitted infection (STI) closely related to human immunodeficiency virus-1 (HIV-1). HTLV-1 causes chronic infection, can be transmitted from mother to baby and is associated with significant disease burden and mortality, preceded by years of suffering and poor quality of life for victims.   

Therefore, HTLV-1 is one of the 2030 elimination targets of the World Health Organization’s global STI elimination strategy.  

Although there is currently no drug or vaccine available to cure HTLV-1, we now know that the very same drugs that effectively treat patients with HIV or prevent people from getting HIV-1, called HIV PrEP, also prevent the transmission of HTLV-1 in our laboratory testing (Reviewed in Bradshaw and Taylor, Frontiers in Medicine 2022). We believe that these compounds are likely to block the transmission from mother to child. 

It is well known that many HIV PrEP clinical trials are conducted in countries where HTLV-1 is common. So, by adding in HTLV-1 testing to these HIV-PrEP trials we could measure if the HIV PrEP drugs also prevent HTLV-1 transmission. The beauty of such an outcome would be that these HIV-1 drugs are already licensed to be used in humans.  

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Embracing doubt in science

Nana-Marie Lemm, Clinical Research Fellow

Why is ‘doubt’ an important resource in science? How can we support the kind of science that takes intellectual risks – and takes time? Nana-Marie Lemm, Clinical Research Fellow at the Department of Infectious Disease, gives her reflections on the recent Day of Doubt conference, organised by the Good Science Project. 

What are the motivations for becoming a scientist? It might be the search for truth or to understand how things work, or to work towards a greater good. But how does that idea compare to the reality of the day-to day work of science, and the culture of doing science? 

The Day of Doubt was the first conference of its kind at Imperial College London. Organised by The Good Science Project, the conference aimed to reflect on research culture at the university level and beyond. It provided a space for discussion, reflection, and the opportunity to ask fundamental questions.  

So, what is ‘doubt’ and why might it be important in science? The team behind the Good Science Project have helpfully created a thesaurus of doubt and a memo document on the day. In the latter, Dr Anthea Lacchia writes:  

“If we take doubt to be the opposite of complacency, it is associated with pause, with thoughtful hesitation. Yet, this act of questioning, of taking necessary time before making a decision, seems at odds with the push for success, publications, and the need for high impact results. In truth, science is full of conflicts, some internal, some relating to wider culture.”  

On the day, there was the opportunity to take time to engage in the act of questioning. Reflective sessions ranged from questioning concepts such as, ‘public engagement,’ ‘interdisciplinarity,’ ‘excellence,’ ‘expertise,’ to delving into philosophical discussions surrounding the nature of scientific truth. 

A key question to speakers in the first session of the conference that resonated with me was,  “How do you talk about doubt when you don’t come from a position of seniority and confidence?” 

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“Why am I depressed, doc?” Experiences of an HIV clinician and researcher

HIV Stop Stigma

Despite major progress in treatment and prevention, being diagnosed with HIV can have a big emotional impact on individuals. People with HIV have higher rates of mental health problems than those seen in the general population. One reason for this may be HIV-related stigma, explains Professor Alan Winston from the Department of Infectious Disease. 

Since the late 1990s, I have been treating people living with HIV and been involved in HIV clinical research. Many things we read about HIV are success stories, and quite rightly we should celebrate these tremendous scientific and medical advances. Life expectancy for someone with HIV is now similar to that of the general population. Antiretroviral therapy generally has manageable side effects and for most individuals, does not incur that many tablets per day. Indeed, many HIV treatments involve taking only one tablet per day. So, why then do so many people with HIV suffer from depression, other mental health conditions, and a poorer quality of life? 

Experience in clinic 

Most people living with HIV, once on a stable treatment, will attend their treatment centre twice per year. Often appointments rotate between a consultant or medical doctor once per year and a nurse specialist on the other occasion. As we can’t cure HIV, our patients attend for life, and we get to know them very well. At consultations, in addition to routine monitoring, we ask people how they are keeping. What stands out are the number of individuals who report symptoms of depression and other mental health conditions such as anxiety. Whilst many of us suffer from mental health complaints, the burden of these complaints in people living with HIV is very high. Thankfully, we do have help in clinic and have a specific clinic run by a psychiatry nurse specialist we can refer patients to. 

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