HIV/AIDS Research Breakthroughs
In this interview, we discuss HIV/AIDS research with Dr.Rachel Bender Ignacio, a physician-scientist and leading infectious-disease researcher at Fred Hutch Cancer Center, where she serves as Assistant Professor in the Vaccine & Infectious Disease Division. She’s also the Principal Investigator and Director of UW Positive Research — a major clinical-trials site affiliated with the AIDS Clinical Trials Group (ACTG) — and is a driving force behind cutting-edge HIV/AIDS research worldwide.
With a training background in global health, epidemiology, and internal medicine (MD and MPH from University of Washington), Dr. Bender Ignacio has devoted her career to studying the many facets of HIV — from prevention and long-acting therapies to co-infections (like herpesviruses and tuberculosis), immune-system behavior, and the intersection of HIV with cancer and other comorbidities.
Beyond HIV, she has led critical response efforts during global health crises: from founding and directing Fred Hutch’s COVID-19 Clinical Research Center (2020–2024) to shaping clinical-trial design under pressure — proving she excels when the stakes are highest.
Dr. Bender Ignacio doesn’t just do research; she embodies the mission behind it. Her work is about real people: communities affected by HIV, patients juggling co-infections or cancer, and those historically marginalized by inequality in care or access. Her dedication lies in bridging scientific innovation with compassionate, equitable care.
Fred Hutchinson Cancer Center Socials
Homepage: https://www.fredhutch.org/
Facebook: https://www.facebook.com/HutchinsonCenter
X: https://x.com/fredhutch
LinkedIn: https://www.linkedin.com/company/fredhutch/
TikTok: tiktok.com/@fredhutch
YouTube: https://www.youtube.com/fredhutch
Instagram: https://instagram.com/fredhutch
Dr. Bender Igancio
ORCID: https://orcid.org/0000-0001-6167-1447
Fred Hutchinson: https://www.fredhutch.org/en/faculty-lab-directory/bender-ignacio-rachel.html
UW Positive Research: https://www.uwpositiveresearch.com/
Hope Group: https://research.fredhutch.org/hope/
NIH Bibliography: https://www.ncbi.nlm.nih.gov/myncbi/rachel.bender%20ignacio.1/bibliography/public/
The following transcript was created using the WhisperKit Model with Large V2 settings. It’s accuracy is not guarenteed.
Dr. Bálint Kacsoh
00:01 - 00:03
Welcome back to an episode of Science Streams.
Dr. Bálint Kacsoh
00:04 - 00:04
This episode,
Dr. Bálint Kacsoh
00:04 - 00:09
we are raising money for HIV/AIDS research in collaboration with the Fred Hutch Cancer Research Center.
Dr. Bálint Kacsoh
00:10 - 00:12
We also had special guests on today,
Dr. Bálint Kacsoh
00:12 - 00:12
Dr.
Dr. Bálint Kacsoh
00:12 - 00:13
Rachel Bender-Ignacio.
Dr. Bálint Kacsoh
00:14 - 00:14
Dr.
Dr. Bálint Kacsoh
00:14 - 00:20
Rachel Bender-Ignacio is a physician scientist and a leading infectious disease researcher at Fred Hutch Cancer Center,
Dr. Bálint Kacsoh
00:21 - 00:24
where she serves as assistant professor in the Vaccine and Infectious Disease Division.
Dr. Bálint Kacsoh
00:25 - 00:28
She's also principal investigator and the director of UW Positive Research,
Dr. Bálint Kacsoh
00:29 - 00:33
a major clinical trials affiliated site with AIDS Clinical Trial Groups,
Dr. Bálint Kacsoh
00:33 - 00:34
ACTG,
Dr. Bálint Kacsoh
00:34 - 00:38
and is a driving force behind cutting-edge research of HIV/AIDS worldwide.
Dr. Bálint Kacsoh
00:39 - 00:41
With training background in global health,
Dr. Bálint Kacsoh
00:41 - 00:42
epidemiology,
Dr. Bálint Kacsoh
00:42 - 00:43
and internal medicine,
Dr. Bálint Kacsoh
00:43 - 00:46
MD and MPH both from the University of Washington,
Dr. Bálint Kacsoh
00:46 - 00:47
Dr.
Dr. Bálint Kacsoh
00:47 - 00:51
Bender Ignacio has devoted her research career to studying many facets of HIV,
Dr. Bálint Kacsoh
00:52 - 00:56
from prevention and long-lasting therapies to co-infections like with herpes,
Dr. Bálint Kacsoh
00:57 - 00:57
viruses,
Dr. Bálint Kacsoh
00:57 - 00:58
and tuberculosis,
Dr. Bálint Kacsoh
00:59 - 00:59
immune system behavior,
Dr. Bálint Kacsoh
01:00 - 01:04
and the intersection of HIV with cancer and other co-morbidities.
Dr. Bálint Kacsoh
01:05 - 01:05
Beyond HIV,
Dr. Bálint Kacsoh
01:05 - 01:09
she has led critical response efforts during global health crises,
Dr. Bálint Kacsoh
01:09 - 01:14
from founding and directing Fred Hutch's COVID-19 Critical Research Center from 2020 to 2024,
Dr. Bálint Kacsoh
01:14 - 01:17
to shaping clinical trial design under pressure,
Dr. Bálint Kacsoh
01:17 - 01:19
proving she excels when the stakes are the highest.
Dr. Bálint Kacsoh
01:20 - 01:20
Dr.
Dr. Bálint Kacsoh
01:20 - 01:22
Benignazio doesn't just do research,
Dr. Bálint Kacsoh
01:22 - 01:24
she embodies the mission behind it.
Dr. Bálint Kacsoh
01:24 - 01:26
Her work is about real people,
Dr. Bálint Kacsoh
01:26 - 01:28
communities affected by HIV,
Dr. Bálint Kacsoh
01:28 - 01:30
patients juggling co-infections or cancer,
Dr. Bálint Kacsoh
01:31 - 01:34
and those historically marginalized by inequity in care or access.
Dr. Bálint Kacsoh
01:35 - 01:39
Her dedication lies in bridging the scientific innovation with compassionate,
Dr. Bálint Kacsoh
01:39 - 01:40
equitable care.
Dr. Bálint Kacsoh
01:40 - 01:42
When you tune into this episode,
Dr. Bálint Kacsoh
01:42 - 01:43
you hear from Dr.
Dr. Bálint Kacsoh
01:43 - 01:43
Bender Ignacio.
Dr. Bálint Kacsoh
01:44 - 01:53
You're hearing from one of the forefront investigators striving towards long-lasting change in global HIV/AIDS is understanding treatment and prevention.
Dr. Bálint Kacsoh
01:53 - 01:54
And with that,
Dr. Bálint Kacsoh
01:54 - 01:55
enjoy the show.
Dr. Bálint Kacsoh
01:59 - 02:03
So we already had a comment just before we get the intro about your earrings.
Dr. Bálint Kacsoh
02:03 - 02:04
Now,
Dr. Bálint Kacsoh
02:04 - 02:06
to be fully transparent,
Dr. Bálint Kacsoh
02:06 - 02:06
y'all,
Dr. Bálint Kacsoh
02:06 - 02:10
we chatted earlier today and did a little test of the camera systems.
Dr. Bálint Kacsoh
02:11 - 02:13
And I had a question about your earrings,
Dr. Bálint Kacsoh
02:13 - 02:13
but I was like,
Dr. Bálint Kacsoh
02:13 - 02:14
"Surely,
Dr. Bálint Kacsoh
02:14 - 02:17
I'm missing." And then we spoke in an email and I'm like,
Dr. Bálint Kacsoh
02:18 - 02:18
"Oh,
Dr. Bálint Kacsoh
02:18 - 02:21
I didn't miss see at all." and telling us about your earrings.
Dr. Bender Igancio
02:22 - 02:23
- Oh yes,
Dr. Bender Igancio
02:23 - 02:25
I am wearing condom earrings that I made myself.
Dr. Bálint Kacsoh
02:27 - 02:28
- There you all go.
Dr. Bálint Kacsoh
02:28 - 02:30
It is in fact condom earrings.
Dr. Bálint Kacsoh
02:30 - 02:30
I was like,
Dr. Bálint Kacsoh
02:30 - 02:31
there's no way.
Dr. Bálint Kacsoh
02:31 - 02:31
There's like,
Dr. Bálint Kacsoh
02:31 - 02:32
I can't,
Dr. Bálint Kacsoh
02:32 - 02:32
I can't ask.
Dr. Bender Igancio
02:34 - 02:40
- It is both days today and your people who you thought might scare me off with their streaking definitely did not scare me off.
Dr. Bender Igancio
02:40 - 02:43
'Cause all I do all days talk about sex and you know,
Dr. Bender Igancio
02:43 - 02:43
sexual health,
Dr. Bender Igancio
02:43 - 02:44
so.
Dr. Bálint Kacsoh
02:45 - 02:45
- Perfect,
Dr. Bálint Kacsoh
02:45 - 02:46
I love it.
Dr. Bálint Kacsoh
02:46 - 02:47
And again,
Dr. Bálint Kacsoh
02:47 - 02:47
your shirt,
Dr. Bálint Kacsoh
02:47 - 02:49
not taking pride in research,
Dr. Bálint Kacsoh
02:49 - 02:51
Like just the message of that too,
Dr. Bálint Kacsoh
02:51 - 02:55
and the like the inclusivity of pulling everyone into the science is like just,
Dr. Bálint Kacsoh
02:55 - 02:57
I appreciate that shirt on many levels.
Dr. Bender Igancio
02:57 - 02:58
- Thank you.
Dr. Bender Igancio
02:58 - 02:58
Well,
Dr. Bender Igancio
02:58 - 03:01
I'll have to show you the back and then you can see our logos.
Dr. Bender Igancio
03:01 - 03:03
So my research center is at the bottom,
Dr. Bender Igancio
03:03 - 03:04
UW Positive Research,
Dr. Bender Igancio
03:04 - 03:06
and then the Fred Hutch logo up at the top.
Dr. Bender Igancio
03:07 - 03:11
So that's our two research centers put together,
Dr. Bender Igancio
03:11 - 03:15
the HIV vaccine research center that's based at the Hutch.
Dr. Bender Igancio
03:15 - 03:19
And then mine is UW Positive Research focused on treatment and cure studies,
Dr. Bender Igancio
03:20 - 03:21
as well as comorbidities research.
Dr. Bender Igancio
03:21 - 03:23
So other viral infections,
Dr. Bender Igancio
03:23 - 03:23
addiction,
Dr. Bender Igancio
03:24 - 03:25
various things like that.
Speaker 1
03:26 - 03:26
Yeah.
Dr. Bálint Kacsoh
03:27 - 03:28
- Awesome.
Dr. Bálint Kacsoh
03:29 - 03:29
Rachel,
Dr. Bálint Kacsoh
03:29 - 03:36
if you wouldn't mind just a brief introduction on who you are and what is your current avenue of research.
Dr. Bálint Kacsoh
03:36 - 03:42
And then we're gonna get into a little bit of the backstory and then really dig into the science that you're working on today.
Dr. Bender Igancio
03:43 - 03:43
- Yeah,
Dr. Bender Igancio
03:43 - 03:43
absolutely.
Dr. Bender Igancio
03:44 - 03:46
So I'm a physician scientist,
Dr. Bender Igancio
03:46 - 03:48
which means that I'm an MD.
Dr. Bender Igancio
03:49 - 03:50
I do not have a PhD.
Dr. Bender Igancio
03:50 - 03:52
Some physician scientists have an MD and a PhD.
Dr. Bender Igancio
03:52 - 03:54
I'm not quite that fancy.
Dr. Bender Igancio
03:54 - 03:59
I only have a master's degree in epidemiology in addition to my MD.
Dr. Bender Igancio
04:00 - 04:07
But I mainly do clinical trials and clinical epidemiology on HIV and associated conditions,
Dr. Bender Igancio
04:07 - 04:08
including cancer.
Dr. Bender Igancio
04:09 - 04:13
Also have a focus on cancer in people living with HIV.
Dr. Bender Igancio
04:13 - 04:16
And I take care of real people with and without HIV.
Dr. Bender Igancio
04:16 - 04:21
I take care of people with other infections and I study HIV in people.
Dr. Bálint Kacsoh
04:22 - 04:24
- And we have a quick question in the chat is that,
Dr. Bálint Kacsoh
04:24 - 04:26
do you have preferred pronouns to use?
Dr. Bender Igancio
04:27 - 04:28
- She/her is perfectly fine.
Speaker 1
04:29 - 04:29
- There you go.
Dr. Bálint Kacsoh
04:30 - 04:32
So before we get into again the background,
Dr. Bálint Kacsoh
04:33 - 04:37
that already sounds like a really unique avenue of research and a really unique trajectory,
Dr. Bálint Kacsoh
04:38 - 04:38
right?
Dr. Bálint Kacsoh
04:38 - 04:44
Did you know for the longest time that it would be something that you'd be interested in in both the intersection of cancer and HIV,
Dr. Bálint Kacsoh
04:45 - 04:47
or is this relatively new in the research journey?
Dr. Bálint Kacsoh
04:47 - 04:48
How does one identify?
Dr. Bálint Kacsoh
04:48 - 04:49
'Cause there's clearly a need for it,
Dr. Bálint Kacsoh
04:49 - 04:49
right?
Dr. Bálint Kacsoh
04:49 - 04:53
Like we know this is a need for this research today,
Dr. Bálint Kacsoh
04:53 - 04:59
but how did you identify and kind of end up at this really unique part of research?
Dr. Bender Igancio
05:01 - 05:01
- Yeah,
Dr. Bender Igancio
05:01 - 05:01
I mean,
Dr. Bender Igancio
05:01 - 05:03
I think a lot of science,
Dr. Bender Igancio
05:03 - 05:05
a lot of people's careers is serendipity,
Dr. Bender Igancio
05:05 - 05:09
and it's hard to say that because you can't prescribe somebody serendipity.
Dr. Bender Igancio
05:09 - 05:10
So when folks ask me,
Dr. Bender Igancio
05:10 - 05:11
how do I do what you did?
Dr. Bender Igancio
05:11 - 05:14
and to say serendipity in some ways feels a little bit rude,
Dr. Bender Igancio
05:14 - 05:17
but that's really how we got there.
Dr. Bender Igancio
05:18 - 05:22
I've always been interested in HIV since before I went into medical school.
Dr. Bender Igancio
05:23 - 05:26
It's in terms of an infection or a condition,
Dr. Bender Igancio
05:28 - 05:31
what really draws me to it is that it has a biologic underpinning.
Dr. Bender Igancio
05:31 - 05:33
It's a puzzle that we haven't completely solved yet,
Dr. Bender Igancio
05:33 - 05:34
but most importantly,
Dr. Bender Igancio
05:34 - 05:36
it impacts people,
Dr. Bender Igancio
05:36 - 05:36
societies.
Dr. Bender Igancio
05:37 - 05:38
It's based in religion.
Dr. Bender Igancio
05:39 - 05:42
it's based in our conceptions about morals,
Dr. Bender Igancio
05:43 - 05:48
that all sort of surrounds HIV in a way that really no other condition does.
Dr. Bender Igancio
05:48 - 05:52
And so I just like the fact that the solutions to HIV is both the biology,
Dr. Bender Igancio
05:52 - 05:55
but it's also changing structures,
Dr. Bender Igancio
05:55 - 05:56
it's changing politics,
Dr. Bender Igancio
05:56 - 06:06
it's having society react to HIV and the solutions for it and people who are impacted by HIV in a different way.
Dr. Bender Igancio
06:07 - 06:13
So HIV kind of all the way along and then I became really interested in TB and HIV co-infection.
Dr. Bender Igancio
06:14 - 06:20
TB being one of the largest killers of people living with HIV and one of the most common causes of infectious disease death globally.
Dr. Bender Igancio
06:22 - 06:31
And then when I ended up in my infectious disease fellowship after residency and was looking for research mentors,
Dr. Bender Igancio
06:31 - 06:34
I thought about doing TB and HIV together,
Dr. Bender Igancio
06:34 - 06:36
realized I'd have to move to Kenya,
Dr. Bender Igancio
06:36 - 06:42
which I think is a great sort of research hub at the University of Washington.
Dr. Bender Igancio
06:43 - 06:49
But at the time I had a three month old and a husband who wasn't necessarily keen about moving overseas.
Dr. Bender Igancio
06:49 - 06:54
And I ended up meeting a mentor who was focusing on HIV associated cancers in Uganda.
Dr. Bender Igancio
06:55 - 06:58
And I could do that work while traveling back and forth to Uganda.
Dr. Bender Igancio
06:58 - 07:04
And there's really a lot of parallels between the problems that we see with HIV and cancer and HIV and TB.
Dr. Bender Igancio
07:04 - 07:06
And so really got into it,
Dr. Bender Igancio
07:06 - 07:07
got really excited about it.
Dr. Bender Igancio
07:07 - 07:12
And it started a new pathway and now I've wandered back again.
Dr. Bálint Kacsoh
07:12 - 07:26
So - How difficult was it just from like a new mom perspective and just being a woman in STEM that traveling to and from Uganda and then doing research,
Dr. Bálint Kacsoh
07:26 - 07:28
like that seems like it's a pretty big lift,
Dr. Bálint Kacsoh
07:28 - 07:28
right?
Speaker 1
07:29 - 07:29
- Yeah,
Speaker 1
07:30 - 07:30
I mean,
Dr. Bender Igancio
07:30 - 07:34
I think people say it's never an easy time to become a parent.
Dr. Bender Igancio
07:34 - 07:37
I don't know that we choose the best time,
Dr. Bender Igancio
07:37 - 07:39
but if somebody decides to become a parent,
Dr. Bender Igancio
07:39 - 07:41
you do it and figure everything else out.
Dr. Bender Igancio
07:42 - 07:49
I think probably the more challenging thing was being a first year infectious disease fellow working in theory 80 hours a week.
Dr. Bender Igancio
07:49 - 07:50
It was often more than that.
Dr. Bender Igancio
07:50 - 07:55
I think we've done a better job of it these days of kind of keeping the lid on it to 80 hours a week,
Dr. Bender Igancio
07:55 - 07:56
but nursing,
Dr. Bender Igancio
07:57 - 07:57
a baby,
Dr. Bender Igancio
07:58 - 07:59
trying to do all of that.
Dr. Bender Igancio
07:59 - 08:03
And then I didn't travel internationally until my older daughter was,
Dr. Bender Igancio
08:04 - 08:06
I think about 18 months old.
Dr. Bálint Kacsoh
08:07 - 08:07
- Not right away.
Dr. Bálint Kacsoh
08:08 - 08:08
Yeah,
Dr. Bálint Kacsoh
08:08 - 08:08
that's how I was like,
Dr. Bálint Kacsoh
08:08 - 08:08
oh,
Dr. Bálint Kacsoh
08:08 - 08:09
three months,
Dr. Bálint Kacsoh
08:09 - 08:10
then it's just like you immediately,
Dr. Bálint Kacsoh
08:10 - 08:11
I have to ship off or something.
Dr. Bender Igancio
08:12 - 08:12
- No,
Dr. Bender Igancio
08:12 - 08:14
but I was working crazy hours,
Dr. Bender Igancio
08:15 - 08:17
and a lot of people in medicine do,
Dr. Bender Igancio
08:17 - 08:18
and a lot of people in science do.
Dr. Bender Igancio
08:18 - 08:19
And so that's,
Dr. Bender Igancio
08:19 - 08:24
it's just really challenging and having a really supportive spouse was really,
Dr. Bender Igancio
08:24 - 08:25
really important still,
Dr. Bender Igancio
08:25 - 08:26
was really,
Dr. Bender Igancio
08:26 - 08:26
really important.
Dr. Bálint Kacsoh
08:27 - 08:28
- So for those at home,
Dr. Bálint Kacsoh
08:28 - 08:29
we haven't really,
Dr. Bálint Kacsoh
08:29 - 08:33
I don't think we've ever had on someone like this intern specialization like you were doing.
Dr. Bálint Kacsoh
08:34 - 08:35
Is this the equivalent of,
Dr. Bálint Kacsoh
08:35 - 08:36
let's say,
Dr. Bálint Kacsoh
08:36 - 08:39
a postdoctoral research fellow if you go down the PhD route,
Dr. Bálint Kacsoh
08:39 - 08:39
where it's,
Dr. Bálint Kacsoh
08:39 - 08:39
again,
Dr. Bálint Kacsoh
08:39 - 08:40
very,
Dr. Bálint Kacsoh
08:40 - 08:41
very heavy on the research,
Dr. Bálint Kacsoh
08:42 - 08:42
but for you,
Dr. Bálint Kacsoh
08:42 - 08:43
it's also seeing patients?
Dr. Bálint Kacsoh
08:43 - 08:44
Like,
Dr. Bálint Kacsoh
08:44 - 08:45
what's the nuance there of that training?
Dr. Bender Igancio
08:46 - 08:46
- Yeah,
Dr. Bender Igancio
08:46 - 08:48
it's a little bit of both.
Dr. Bender Igancio
08:48 - 08:57
So the way that clinical specializations work is that they generally happen after either internal medicine residency or pediatrics residency,
Dr. Bender Igancio
08:57 - 08:59
depending on which flavor.
Dr. Bender Igancio
08:59 - 09:03
there's also general surgery residency and subspecialties after that.
Dr. Bender Igancio
09:04 - 09:05
But so I did internal medicine residency,
Dr. Bender Igancio
09:05 - 09:07
which is three years after medical school,
Dr. Bender Igancio
09:08 - 09:10
and then infectious disease fellowship,
Dr. Bender Igancio
09:10 - 09:15
which in order to be board eligible to be a clinical infectious disease doc is two years.
Dr. Bender Igancio
09:17 - 09:24
But most folks that are doing kind of the academic post-doc component to it as well do three and sometimes four.
Dr. Bender Igancio
09:25 - 09:32
So that's sort of combining that clinical postdoctoral training that would allow you to see an infectious disease specialist,
Dr. Bender Igancio
09:33 - 09:36
same kind of pathway to see a cardiologist or an endocrinologist.
Dr. Bender Igancio
09:37 - 09:43
But then I did an additional research fellowship that's like considered to be a postdoc without a PhD.
Dr. Bálint Kacsoh
09:43 - 09:44
- That's really,
Dr. Bálint Kacsoh
09:44 - 09:45
really cool.
Dr. Bálint Kacsoh
09:45 - 09:45
And it just also,
Dr. Bálint Kacsoh
09:45 - 09:46
like you said,
Dr. Bálint Kacsoh
09:46 - 09:48
the 80 hours a week plus a new kid,
Dr. Bálint Kacsoh
09:48 - 09:49
like that's,
Dr. Bálint Kacsoh
09:50 - 09:50
it's kind of a,
Dr. Bálint Kacsoh
09:50 - 09:54
it's a Herculean effort that I feel like kind of goes understated,
Dr. Bálint Kacsoh
09:54 - 09:54
right?
Dr. Bálint Kacsoh
09:54 - 09:56
Of like how much work goes into something like this.
Dr. Bálint Kacsoh
09:56 - 10:00
Like you really have to love and be about what you're doing to go down this route.
Dr. Bálint Kacsoh
10:01 - 10:07
Was there something that made you like really interested in this intersection of co-infection?
Dr. Bálint Kacsoh
10:07 - 10:07
Co,
Dr. Bálint Kacsoh
10:07 - 10:07
you know,
Dr. Bálint Kacsoh
10:07 - 10:08
'cause it's,
Dr. Bálint Kacsoh
10:09 - 10:10
it feels like it goes kind of understated,
Dr. Bálint Kacsoh
10:11 - 10:11
underreported,
Dr. Bálint Kacsoh
10:11 - 10:12
right?
Dr. Bálint Kacsoh
10:12 - 10:14
Like there used to be a lot of reporting on AIDS,
Dr. Bálint Kacsoh
10:14 - 10:14
HIV,
Dr. Bálint Kacsoh
10:14 - 10:17
when people were actively dying,
Dr. Bálint Kacsoh
10:17 - 10:19
just like not living past like the thirties,
Dr. Bálint Kacsoh
10:19 - 10:20
right?
Dr. Bálint Kacsoh
10:20 - 10:23
And now all of a sudden it seems a little bit almost swept to the side,
Dr. Bálint Kacsoh
10:23 - 10:24
unfortunately.
Dr. Bálint Kacsoh
10:25 - 10:28
But the research that you're doing makes total sense.
Dr. Bálint Kacsoh
10:28 - 10:28
that's like,
Dr. Bálint Kacsoh
10:28 - 10:28
of course,
Dr. Bálint Kacsoh
10:28 - 10:29
if you're living longer,
Dr. Bálint Kacsoh
10:30 - 10:32
you're gonna get sick from other things,
Dr. Bálint Kacsoh
10:32 - 10:32
right?
Dr. Bálint Kacsoh
10:33 - 10:35
So what was it that kind of pulled you,
Dr. Bálint Kacsoh
10:35 - 10:36
I guess,
Dr. Bálint Kacsoh
10:36 - 10:38
towards this particular journey?
Dr. Bálint Kacsoh
10:38 - 10:39
And why,
Dr. Bálint Kacsoh
10:39 - 10:40
I guess you said,
Dr. Bálint Kacsoh
10:40 - 10:40
you know,
Dr. Bálint Kacsoh
10:40 - 10:41
you keep coming back to it.
Dr. Bálint Kacsoh
10:41 - 10:41
Like,
Dr. Bálint Kacsoh
10:41 - 10:42
what is it,
Dr. Bálint Kacsoh
10:42 - 10:42
like,
Dr. Bálint Kacsoh
10:42 - 10:44
what's the puzzle that's just like so,
Dr. Bálint Kacsoh
10:45 - 10:45
like,
Dr. Bálint Kacsoh
10:45 - 10:47
what's the big benefit for studying this?
Dr. Bender Igancio
10:48 - 10:48
- Yeah,
Dr. Bender Igancio
10:49 - 10:49
I mean,
Dr. Bender Igancio
10:49 - 10:50
I think to go even broader than cancer,
Dr. Bender Igancio
10:51 - 10:54
what we know is that in people who,
Dr. Bender Igancio
10:54 - 10:54
oh,
Dr. Bender Igancio
10:54 - 10:55
I guess I'll just take,
Dr. Bender Igancio
10:55 - 11:03
I'll take a little bit of a step back even further and just kind of ground us all on the same clinical knowledge of what's going on with treating folks with HIV right now.
Dr. Bender Igancio
11:03 - 11:07
So HIV right now is treatable with one pill once a day.
Dr. Bender Igancio
11:09 - 11:11
We also have long acting injectable treatments that some,
Dr. Bender Igancio
11:12 - 11:14
but not a lot of people can access right now,
Dr. Bender Igancio
11:14 - 11:18
which could be an injection every two months and moving towards longer injections.
Dr. Bender Igancio
11:19 - 11:21
But HIV and the sort of,
Speaker 1
11:21 - 11:23
you know,
Dr. Bender Igancio
11:24 - 11:32
the typical manifestations of what can become AIDS is completely preventable,
Dr. Bender Igancio
11:32 - 11:35
completely controllable with one pill once a day,
Dr. Bender Igancio
11:35 - 11:36
or again,
Dr. Bender Igancio
11:36 - 11:37
sort of in special cases,
Dr. Bender Igancio
11:37 - 11:39
these longer acting injectable medications.
Dr. Bender Igancio
11:40 - 11:41
So it's very much a treatable condition,
Dr. Bender Igancio
11:42 - 11:53
but what that means is that people who are accessing HIV treatment are still facing sort of inappropriate amounts of immune activation or inflammation,
Dr. Bender Igancio
11:54 - 11:56
even despite great HIV control.
Dr. Bender Igancio
11:56 - 11:59
And what that results in is an excess risk of cancer,
Dr. Bender Igancio
11:59 - 12:01
an excess risk of heart disease.
Dr. Bender Igancio
12:01 - 12:04
We kind of tend to think of people with HIV,
Dr. Bender Igancio
12:04 - 12:05
with well-controlled HIV,
Dr. Bender Igancio
12:05 - 12:07
is aging about 10 years faster on average.
Dr. Bender Igancio
12:08 - 12:12
So all of the conditions that we kind of think of as we grow older happen earlier in folks,
Dr. Bender Igancio
12:12 - 12:14
even with very well-treated HIV.
Dr. Bender Igancio
12:15 - 12:18
And then because the immune system is in great shape,
Dr. Bender Igancio
12:18 - 12:19
but not perfect shape,
Dr. Bender Igancio
12:19 - 12:20
even on treatment,
Dr. Bender Igancio
12:21 - 12:26
we still see an excess risk of infections and in areas where there's tuberculosis,
Dr. Bender Igancio
12:26 - 12:32
that means tuberculosis still is a leading cause of death in folks with HIV,
Dr. Bender Igancio
12:32 - 12:33
even with well-controlled,
Dr. Bender Igancio
12:33 - 12:34
well-treated HIV.
Dr. Bálint Kacsoh
12:35 - 12:36
- So I guess this take us even,
Dr. Bálint Kacsoh
12:36 - 12:40
I like how we're stepping a lot backwards here 'cause there's so much context to add in here,
Dr. Bálint Kacsoh
12:41 - 12:41
right?
Dr. Bálint Kacsoh
12:41 - 12:45
And so little is like in the public sphere right now about this.
Dr. Bálint Kacsoh
12:47 - 12:51
A question from the chat is treatable and curable are different things,
Dr. Bálint Kacsoh
12:51 - 12:51
right?
Dr. Bálint Kacsoh
12:51 - 12:57
So what does it mean if you are living with HIV/AIDS and you're being,
Dr. Bálint Kacsoh
12:57 - 12:58
it's under control,
Dr. Bálint Kacsoh
12:59 - 12:59
quote unquote,
Dr. Bálint Kacsoh
12:59 - 13:02
what does that look like in terms of patient prognosis?
Dr. Bálint Kacsoh
13:02 - 13:04
And I guess just even further step back,
Dr. Bálint Kacsoh
13:05 - 13:07
why is it so hard to cure this?
Dr. Bender Igancio
13:08 - 13:09
- Yeah,
Dr. Bender Igancio
13:09 - 13:10
those are really great questions.
Dr. Bender Igancio
13:11 - 13:12
And I think part of sort of this,
Dr. Bender Igancio
13:14 - 13:14
you know,
Dr. Bender Igancio
13:14 - 13:15
what we haven't,
Dr. Bender Igancio
13:15 - 13:17
what we've learned about HIV,
Dr. Bender Igancio
13:17 - 13:18
what we've learned,
Dr. Bender Igancio
13:18 - 13:22
how far science has come and how far science still has to go.
Dr. Bender Igancio
13:23 - 13:25
So HIV is a retrovirus,
Dr. Bender Igancio
13:25 - 13:28
which means it starts as RNA,
Dr. Bender Igancio
13:28 - 13:29
it doesn't have any DNA,
Dr. Bender Igancio
13:30 - 13:41
but it works itself into our DNA and then essentially cheats and allows our own cells or requires our own cells that when they photocopy themselves,
Dr. Bender Igancio
13:41 - 13:47
they're also making photocopies of the integrated DNA that it's sort of dropped into our genome,
Dr. Bender Igancio
13:48 - 13:49
specifically in our T cells,
Dr. Bender Igancio
13:49 - 13:51
but in some other cells in the body,
Dr. Bender Igancio
13:51 - 13:52
mainly immune cells.
Dr. Bender Igancio
13:53 - 13:55
And whenever those cells replicate,
Dr. Bender Igancio
13:56 - 13:59
they replicate with HIV integrated into the genome.
Dr. Bender Igancio
14:00 - 14:05
And whenever we transcribe our genome from DNA to RNA,
Dr. Bender Igancio
14:06 - 14:08
we make free photocopies for the virus,
Dr. Bender Igancio
14:09 - 14:13
free being because the virus doesn't have its own machinery to do this necessarily,
Dr. Bender Igancio
14:13 - 14:15
It just has a free ride in our cells,
Dr. Bender Igancio
14:16 - 14:18
and we hope it make copies.
Dr. Bender Igancio
14:18 - 14:22
And then it has the different genes,
Dr. Bender Igancio
14:22 - 14:25
different enzymes to be able to cut itself into pieces,
Dr. Bender Igancio
14:26 - 14:27
or make itself into protein,
Dr. Bender Igancio
14:28 - 14:28
cut itself into pieces,
Dr. Bender Igancio
14:29 - 14:30
reassemble itself as a package,
Dr. Bender Igancio
14:31 - 14:33
and then escape the cell and infect other cells.
Dr. Bender Igancio
14:34 - 14:36
So the technology that we have,
Dr. Bender Igancio
14:36 - 14:38
the basis of all antiretroviral therapy,
Dr. Bender Igancio
14:39 - 14:40
or ART as we call it,
Dr. Bender Igancio
14:41 - 14:46
is essentially impacting one of those places in the life cycle.
Dr. Bender Igancio
14:46 - 14:53
And generally we treat people with two to three medications because HIV is very error prone as it's making all of these photocopies.
Dr. Bender Igancio
14:53 - 14:55
And so we need at least two,
Dr. Bender Igancio
14:55 - 15:00
if not three medications so that we have kind of some backstop so that it can't mutate around our medications.
Dr. Bálint Kacsoh
15:01 - 15:07
- So the bad in this instance of its own DNA is good for it in that it can sort of,
Dr. Bálint Kacsoh
15:07 - 15:09
it's almost like a evolution on speed.
Dr. Bálint Kacsoh
15:10 - 15:11
It's able to rush through it.
Dr. Bender Igancio
15:12 - 15:13
It's evolution on speed.
Dr. Bender Igancio
15:15 - 15:17
And because it can just make so many mistakes,
Dr. Bender Igancio
15:18 - 15:19
inevitably it'll make mistakes.
Dr. Bender Igancio
15:19 - 15:25
And the ones that work are the ones that skirt the medications that are trying to keep their foot down on it.
Dr. Bender Igancio
15:26 - 15:31
And so our medications right now can keep HIV from replicating itself,
Dr. Bender Igancio
15:31 - 15:35
turning itself into an infective virion,
Dr. Bender Igancio
15:35 - 15:36
or a virus,
Dr. Bender Igancio
15:36 - 15:38
and budding and infecting other cells.
Dr. Bender Igancio
15:39 - 15:44
But what we don't have is we have sort of glimpses into and ideas of,
Dr. Bender Igancio
15:44 - 15:46
but not effective treatments,
Dr. Bender Igancio
15:46 - 15:50
which can go in and either remove those DNA,
Dr. Bender Igancio
15:50 - 15:51
chunks of DNA from our cells,
Dr. Bender Igancio
15:53 - 15:55
or that can really prevent it from becoming part of our cells,
Dr. Bender Igancio
15:56 - 16:07
or can get rid of cells that have HIV already in them without just killing all of the cells.
Dr. Bender Igancio
16:07 - 16:12
And so with that kind of part of HIV,
Dr. Bender Igancio
16:12 - 16:14
we call that the latent reservoir.
Dr. Bender Igancio
16:14 - 16:17
So that's the part of HIV that's in DNA,
Dr. Bender Igancio
16:18 - 16:19
in our cells,
Dr. Bender Igancio
16:19 - 16:23
and can just be sort of sleeping there and not doing anything until our cell decides to replicate,
Dr. Bender Igancio
16:24 - 16:28
in which case we start sort of making its photocopies for it.
Dr. Bender Igancio
16:29 - 16:35
And so that latent reservoir is the difference between HIV treatment and cure.
Dr. Bender Igancio
16:36 - 16:39
And this error-proneness is also,
Dr. Bender Igancio
16:39 - 16:43
and the fact that HIV gets into the cells,
Dr. Bender Igancio
16:43 - 16:46
the very cells that we need to protect ourselves from it,
Dr. Bender Igancio
16:47 - 16:51
those are the reasons also why we don't yet have a successful vaccine.
Dr. Bender Igancio
16:52 - 16:54
So if it's constantly mutating,
Dr. Bender Igancio
16:55 - 16:59
we have different neutralizing antibodies that can neutralize HIV,
Dr. Bender Igancio
16:59 - 17:04
but most humans who are living with HIV do make neutralizing antibodies,
Dr. Bender Igancio
17:04 - 17:07
but not until after the HIV has sort of come past that point.
Dr. Bender Igancio
17:08 - 17:10
So we're constantly playing catch up.
Dr. Bender Igancio
17:10 - 17:29
So we have been able to isolate as scientists what are called BNABS or broadly neutralizing antibodies from certain people living with HIV who can make antibodies that neutralize sort of a wide variety of different kind of mutations of HIV.
Dr. Bender Igancio
17:30 - 17:31
But most individuals,
Dr. Bender Igancio
17:32 - 17:40
there are some special cases who either by genetics or other things we don't understand can control HIV without needing medications.
Dr. Bender Igancio
17:41 - 17:43
But the vast majority of people with HIV,
Dr. Bender Igancio
17:43 - 17:45
when they make the right antibodies or the right immune responses,
Dr. Bender Igancio
17:45 - 17:47
they're two steps behind the virus.
Dr. Bender Igancio
17:48 - 17:51
And HIV is living in our helper T cells,
Dr. Bender Igancio
17:51 - 17:54
which are exactly the type of cells that usually go after pathogens like HIV.
Dr. Bender Igancio
17:55 - 17:56
So it's this sort of Trojan horse phenomenon.
Dr. Bender Igancio
17:58 - 18:00
So there's a lot of work going on,
Dr. Bender Igancio
18:00 - 18:06
especially at the Fred Hutch about making vaccines We're the head of the global HIV vaccine trials network.
Dr. Bender Igancio
18:07 - 18:10
And there's a lot of promising immunology going on,
Dr. Bender Igancio
18:10 - 18:12
but it's been very challenging.
Dr. Bender Igancio
18:12 - 18:12
I mean,
Dr. Bender Igancio
18:12 - 18:17
this is probably the most challenging pathogen we've ever faced in terms of finding the vaccine.
Dr. Bálint Kacsoh
18:18 - 18:22
- It's like you were saying the immune system's two steps behind.
Dr. Bálint Kacsoh
18:22 - 18:24
And that's wild to think about,
Dr. Bálint Kacsoh
18:24 - 18:24
right?
Dr. Bálint Kacsoh
18:24 - 18:25
That you're mounting the immune response,
Dr. Bálint Kacsoh
18:25 - 18:28
but the thing that you're targeting is already gone,
Speaker 1
18:29 - 18:29
right?
Dr. Bálint Kacsoh
18:29 - 18:31
It's no longer what matters.
Dr. Bálint Kacsoh
18:31 - 18:31
And it's like,
Dr. Bálint Kacsoh
18:31 - 18:31
well,
Dr. Bálint Kacsoh
18:32 - 18:32
how,
Dr. Bálint Kacsoh
18:32 - 18:34
how do you even combat something like that?
Dr. Bálint Kacsoh
18:34 - 18:34
Right.
Dr. Bálint Kacsoh
18:35 - 18:36
And then on top of it,
Dr. Bálint Kacsoh
18:36 - 18:37
as you were mentioning too,
Dr. Bálint Kacsoh
18:37 - 18:38
if,
Dr. Bálint Kacsoh
18:38 - 18:42
if you're trying to target a particular appearing protein,
Dr. Bálint Kacsoh
18:42 - 18:45
but it's hidden away in a cell and it's not yet active,
Dr. Bálint Kacsoh
18:46 - 18:47
how do you know where that is?
Dr. Bálint Kacsoh
18:47 - 18:49
And how do you end up targeting something like this?
Dr. Bálint Kacsoh
18:49 - 18:50
So it's a,
Dr. Bálint Kacsoh
18:50 - 18:57
it seems like it's one of those giant puzzles and it's almost an evolutionary arms race where you have to catch up,
Dr. Bálint Kacsoh
18:58 - 19:00
but how do you trip someone who's running far ahead of you?
Dr. Bender Igancio
19:01 - 19:02
Exactly,
Dr. Bender Igancio
19:02 - 19:02
exactly.
Dr. Bender Igancio
19:03 - 19:04
And also how do you figure out,
Dr. Bender Igancio
19:04 - 19:18
so as you talked about sort of this Achilles heel also being its benefit is that we now think that the vast majority of the latent HIV reservoir is full of what we call non-replication competent HIV,
Dr. Bender Igancio
19:19 - 19:21
which means that a lot of it is garbage.
Dr. Bender Igancio
19:21 - 19:23
It's non-full length sequences.
Dr. Bender Igancio
19:23 - 19:25
If you try to copy it,
Dr. Bender Igancio
19:25 - 19:37
it wouldn't be able to form itself into a virus that would be capable of packaging itself up and leaving the cell and going on and infecting another cell or being transmitted to another person.
Dr. Bender Igancio
19:37 - 20:01
And so even just sort of seeing the entire elephant at any one point in time is really hard because we just being able to identify which are the cells that contain replication-competent HIV versus that contain just sort of artifactual remnants that it has laid down and integrated into our own genome.
Dr. Bender Igancio
20:02 - 20:03
So it's very challenging.
Dr. Bálint Kacsoh
20:04 - 20:05
- And then what do the drugs do?
Dr. Bálint Kacsoh
20:06 - 20:06
So if you're on,
Dr. Bálint Kacsoh
20:07 - 20:07
right,
Dr. Bálint Kacsoh
20:07 - 20:09
these three different drug repertoires,
Dr. Bálint Kacsoh
20:09 - 20:11
what is the connection there?
Dr. Bálint Kacsoh
20:11 - 20:20
Like what do those drugs end up doing that I guess slow that progression down that allow an individual patient to have that now normal lifespan,
Dr. Bálint Kacsoh
20:21 - 20:21
right?
Dr. Bálint Kacsoh
20:21 - 20:26
where it's not now a challenge to survive to your old age.
Dr. Bender Igancio
20:28 - 20:28
- Yeah,
Dr. Bender Igancio
20:28 - 20:30
so there's a variety of different mechanisms.
Dr. Bender Igancio
20:30 - 20:31
The newest one,
Dr. Bender Igancio
20:31 - 20:34
the kind of hot sexy one that was the times,
Dr. Bender Igancio
20:36 - 20:55
or that was I think the breakthrough of the year that Time Magazine put out in 2024 and kind of all throughout the world is a medication called Lenicapavir that now is proven to be almost 100% or 100% effective at preventing HIV acquisition when taken as a twice yearly shot.
Dr. Bender Igancio
20:55 - 20:56
So this is phenomenal.
Dr. Bender Igancio
20:57 - 20:59
That medication is called a capsid inhibitor,
Dr. Bender Igancio
21:00 - 21:04
which works in actually three different places in the life cycle of HIV.
Dr. Bender Igancio
21:04 - 21:07
It prevents it from sort of taking the capsid,
Dr. Bender Igancio
21:07 - 21:09
which is the kind of capsule that the virus is in.
Dr. Bender Igancio
21:09 - 21:22
It prevents it from disassembling itself so it can enter the nucleus and it prevents itself from reassembling itself when it's trying to kind of go the other direction and make new virus and it prevents it from being able to butt out.
Dr. Bender Igancio
21:23 - 21:28
We have nucleoside reverse transcriptase inhibitors,
Dr. Bender Igancio
21:28 - 21:29
which kind of prevent,
Dr. Bender Igancio
21:30 - 21:31
they do chain termination,
Dr. Bender Igancio
21:31 - 21:38
so they prevent that RNA from getting turned into DNA because they gum up our transcriptases,
Dr. Bender Igancio
21:38 - 21:51
the human transcriptases that would be sort of reading the sequence and helping lay down those copies protease inhibitors which prevent those sequences of proteins that are,
Dr. Bender Igancio
21:51 - 21:58
get spit out from getting cut up into the pieces to turn into the right pieces of HIV to be able to reassemble themselves.
Dr. Bender Igancio
21:59 - 22:09
So essentially what they do is prevent someone from having the ability to have cell to cell infection in their own body that would then harm their own immune system.
Dr. Bender Igancio
22:10 - 22:15
And so when we stop killing other immune cells within our body,
Dr. Bender Igancio
22:15 - 22:17
we're able to have a totally normal immune,
Dr. Bender Igancio
22:18 - 22:18
well,
Dr. Bender Igancio
22:18 - 22:28
almost normal immune system that is capable of fending off all of the other pathogens that our T helper cells and our macrophages are generally keeping us safe from.
Speaker 1
22:29 - 22:29
Bacteria,
Dr. Bender Igancio
22:29 - 22:30
fungus,
Dr. Bender Igancio
22:30 - 22:31
other viruses,
Dr. Bender Igancio
22:33 - 22:47
most commonly folks with advanced HIV who are not on medications who get diagnosed very late have the hardest time with other viral infections and fungi and micro bacterial infections like TB because those are intracellular pathogens.
Dr. Bender Igancio
22:47 - 22:51
So things that are inside our cells and we need those T helper cells to be able to attack those.
Dr. Bender Igancio
22:53 - 23:01
And really the other amazing phenomenal thing about HIV treatment is that because we're not making replication competent virus,
Dr. Bender Igancio
23:02 - 23:06
we're not making whole viruses that are going out into our body and infecting cell to cell,
Dr. Bender Igancio
23:06 - 23:09
we also don't measure the viral RNA in our blood.
Dr. Bender Igancio
23:09 - 23:11
We're not seeing any of the viral RNA,
Dr. Bender Igancio
23:11 - 23:14
which means that we can't transmit it to anybody else.
Dr. Bender Igancio
23:14 - 23:16
So say this with me,
Dr. Bender Igancio
23:16 - 23:25
the risk of transmitting HIV to someone is zero when people are effectively taking their HIV medications.
Dr. Bender Igancio
23:26 - 23:27
It's not almost zero.
Dr. Bender Igancio
23:28 - 23:30
It's not probably not going to happen.
Dr. Bender Igancio
23:30 - 23:31
It is zero.
Dr. Bender Igancio
23:31 - 23:34
So that is what we call treatment is prevention,
Dr. Bender Igancio
23:35 - 23:37
it's really a message that,
Dr. Bender Igancio
23:37 - 23:37
you know,
Dr. Bender Igancio
23:37 - 23:45
more people need to hear is that amazing message that HIV treatment not only protects the person who's taking that medication,
Dr. Bender Igancio
23:45 - 23:51
but also makes it impossible if they're taking their medication well to pass it on to a central partner.
Dr. Bálint Kacsoh
23:52 - 23:56
I think that's a critical thing that's mis misinformed,
Dr. Bálint Kacsoh
23:57 - 23:59
misidentified to a lot of people that chance of being zero,
Dr. Bálint Kacsoh
24:00 - 24:00
right?
Dr. Bálint Kacsoh
24:00 - 24:00
It's always like,
Dr. Bálint Kacsoh
24:00 - 24:00
oh,
Dr. Bálint Kacsoh
24:01 - 24:02
there's a little bit of a chance,
Dr. Bálint Kacsoh
24:02 - 24:02
right?
Dr. Bálint Kacsoh
24:02 - 24:03
And that's huge.
Dr. Bálint Kacsoh
24:04 - 24:05
And that's a big breakthrough.
Dr. Bender Igancio
24:06 - 24:06
Yeah,
Dr. Bender Igancio
24:06 - 24:10
it took the the US CDC a long time to say it was zero,
Dr. Bender Igancio
24:10 - 24:12
even after the WHO said that it was zero.
Dr. Bender Igancio
24:14 - 24:20
But it took having thousands of people and millions of people having sex with people who are zero different,
Dr. Bender Igancio
24:20 - 24:21
meaning one partner has HIV,
Dr. Bender Igancio
24:21 - 24:23
one partner doesn't have HIV,
Dr. Bender Igancio
24:23 - 24:25
to really say that the risk was 000.
Dr. Bender Igancio
24:26 - 24:29
And they did a huge study in East Africa.
Dr. Bender Igancio
24:29 - 24:29
And essentially,
Dr. Bender Igancio
24:29 - 24:33
what they found was that there were a few transmissions of HIV.
Dr. Bender Igancio
24:34 - 24:37
And in every single case after studying millions,
Dr. Bender Igancio
24:37 - 24:37
I mean,
Dr. Bender Igancio
24:37 - 24:40
it was like thousands of people who had sex millions of times.
Dr. Bender Igancio
24:40 - 24:41
In every single case,
Dr. Bender Igancio
24:42 - 24:48
either the person who was living with HIV in that partnership was not taking their medications and their virus was not suppressed,
Dr. Bender Igancio
24:49 - 24:55
or the partner who acquired HIV's sequence didn't match the partner that they thought it was from,
Dr. Bender Igancio
24:55 - 24:58
which means that they got HIV from outside their house.
Dr. Bender Igancio
24:58 - 25:00
Which can happen when you're in an endemic setting,
Dr. Bender Igancio
25:00 - 25:00
You know,
Dr. Bender Igancio
25:00 - 25:02
if you live in a country with 10% of people,
Dr. Bender Igancio
25:02 - 25:04
one in 10 people are living with HIV.
Dr. Bender Igancio
25:05 - 25:09
And one of your partners is doing a great job of taking their medications and there's somebody else,
Dr. Bender Igancio
25:10 - 25:12
then it was very clear that in that study,
Dr. Bender Igancio
25:13 - 25:18
zero of the transmissions were from people whose partner was taking their HIV medication well.
Dr. Bálint Kacsoh
25:20 - 25:23
- And I bet that when there's kind of reporting on something like this,
Dr. Bálint Kacsoh
25:23 - 25:23
you're not,
Dr. Bálint Kacsoh
25:23 - 25:27
like the popular media doesn't necessarily want to report on that side of things,
Dr. Bálint Kacsoh
25:27 - 25:28
but rather it's like,
Dr. Bálint Kacsoh
25:28 - 25:28
oh,
Dr. Bálint Kacsoh
25:28 - 25:29
it's not zero necessarily,
Dr. Bálint Kacsoh
25:29 - 25:31
but you're actually looking at the data itself,
Dr. Bálint Kacsoh
25:32 - 25:37
you're identifying what's happening and you have to identify all these variables when doing this patient data.
Dr. Bálint Kacsoh
25:37 - 25:43
And I think that that dovetails nicely as we are now on the front page carousel,
Dr. Bálint Kacsoh
25:43 - 25:43
Rachel.
Dr. Bálint Kacsoh
25:44 - 25:45
We're on the front page of Twitch now.
Dr. Bálint Kacsoh
25:47 - 25:50
Could you dive a little bit into some of your research now?
Dr. Bálint Kacsoh
25:51 - 25:52
The difficulty,
Dr. Bálint Kacsoh
25:52 - 25:54
like you're kind of already touching on it,
Dr. Bálint Kacsoh
25:54 - 25:56
the difficulty of working with humans,
Dr. Bálint Kacsoh
25:56 - 25:56
right?
Dr. Bálint Kacsoh
25:57 - 26:01
A lot of the guests we've had on have worked on fruit flies and zebrafish and mice,
Dr. Bálint Kacsoh
26:02 - 26:02
right?
Dr. Bálint Kacsoh
26:02 - 26:03
But here you are,
Dr. Bálint Kacsoh
26:03 - 26:08
you're working with human patients on not just HIV,
Dr. Bálint Kacsoh
26:08 - 26:10
but other factors as well.
Dr. Bálint Kacsoh
26:11 - 26:19
What is the big research question that you're chasing right now and how will fundraising efforts help you achieve something like this?
Dr. Bender Igancio
26:20 - 26:20
- I mean,
Dr. Bender Igancio
26:20 - 26:22
that's such a huge question.
Dr. Bender Igancio
26:22 - 26:24
I wanna say it's the million dollar question because it actually is.
Dr. Bender Igancio
26:25 - 26:26
It's probably more than a million dollars.
Dr. Bender Igancio
26:26 - 26:28
definitely more than a million dollars.
Dr. Bender Igancio
26:29 - 26:30
But we're working on several things.
Dr. Bender Igancio
26:31 - 26:35
So and that's great when I'm the director of UW positive research.
Dr. Bender Igancio
26:36 - 26:36
I'm,
Dr. Bender Igancio
26:37 - 26:37
yes,
Dr. Bender Igancio
26:37 - 26:38
we're fundraising for Fred Hutch.
Dr. Bender Igancio
26:38 - 26:40
I have a joint appointment between both places.
Dr. Bender Igancio
26:41 - 26:45
My research unit is physically located at Harborview Medical Center,
Dr. Bender Igancio
26:45 - 26:47
which is our county hospital.
Dr. Bender Igancio
26:47 - 26:49
It's where our very large HIV clinic is located.
Dr. Bender Igancio
26:50 - 26:52
And so makes sense for my research,
Dr. Bender Igancio
26:52 - 26:59
which mainly engages people living with HIV and hepatitis and other infections to be coming to,
Dr. Bender Igancio
26:59 - 27:07
but our partner kind of partner organization is the Fred Hutch between myself and our sister unit that studies HIV vaccines.
Dr. Bender Igancio
27:08 - 27:10
So in that research unit,
Dr. Bender Igancio
27:11 - 27:11
you know,
Dr. Bender Igancio
27:11 - 27:16
we can answer more than one question at a time because we have a variety of different clinical trials going on.
Dr. Bender Igancio
27:17 - 27:20
I would say the two main thrusts of our research right now,
Dr. Bender Igancio
27:20 - 27:20
okay,
Dr. Bender Igancio
27:20 - 27:22
three main thrusts of our research right now,
Dr. Bender Igancio
27:23 - 27:24
are one,
Dr. Bender Igancio
27:24 - 27:25
HIV cure.
Dr. Bender Igancio
27:25 - 27:28
So we have a number of studies looking at ways to,
Dr. Bender Igancio
27:29 - 27:30
if not completely,
Dr. Bender Igancio
27:30 - 27:31
cure HIV,
Dr. Bender Igancio
27:32 - 27:36
ways to sort of keep the virus either in lockdown,
Dr. Bender Igancio
27:36 - 27:43
keep it from being able to wake back up out of that latent reservoir without taking medications.
Dr. Bender Igancio
27:44 - 27:44
So that's one.
Dr. Bender Igancio
27:45 - 27:47
I'll HIV cure,
Dr. Bender Igancio
27:47 - 27:47
HIV remission.
Dr. Bender Igancio
27:48 - 27:53
The second bucket of research would be in long acting antiretroviral therapy.
Dr. Bender Igancio
27:54 - 27:59
So asking people to take a pill every day for the rest of their life is very challenging,
Dr. Bender Igancio
27:59 - 28:04
especially if we expect the life expectancy of folks with HIV to be potentially 80 years,
Dr. Bender Igancio
28:05 - 28:06
which it is.
Dr. Bender Igancio
28:06 - 28:07
So,
Dr. Bender Igancio
28:07 - 28:08
you know,
Dr. Bender Igancio
28:08 - 28:09
and people have all sorts of challenges in life.
Dr. Bender Igancio
28:11 - 28:12
People have,
Dr. Bender Igancio
28:12 - 28:12
you know,
Dr. Bender Igancio
28:12 - 28:13
unstable housing,
Dr. Bender Igancio
28:14 - 28:15
people who have mental health issues,
Dr. Bender Igancio
28:15 - 28:16
people have substance use,
Dr. Bender Igancio
28:16 - 28:23
the stigma of putting a pill in your mouth every day reminds you of the condition that you're living with.
Dr. Bender Igancio
28:23 - 28:24
And for some folks,
Dr. Bender Igancio
28:24 - 28:24
that's really,
Dr. Bender Igancio
28:24 - 28:25
really hard.
Dr. Bender Igancio
28:27 - 28:29
So for all of those reasons,
Dr. Bender Igancio
28:30 - 28:34
we're working on longer acting HIV medications that could be injected once a month,
Dr. Bender Igancio
28:34 - 28:35
once every two months,
Dr. Bender Igancio
28:35 - 28:36
maybe once every six months.
Dr. Bender Igancio
28:37 - 28:46
So we have some studies going on there and those studies are specifically focusing on folks who are having a hard time taking their medication every day.
Dr. Bender Igancio
28:47 - 28:54
So folks that have structural problems access to medical care or difficulties taking their medication.
Dr. Bender Igancio
28:55 - 28:58
And then I'd say the third bucket is HIV associated comorbidities.
Dr. Bender Igancio
28:59 - 28:59
So aging,
Dr. Bender Igancio
28:59 - 29:00
cardiovascular disease,
Dr. Bender Igancio
29:01 - 29:01
hepatitis,
Dr. Bender Igancio
29:02 - 29:06
other conditions that disproportionately impact people living with HIV,
Dr. Bender Igancio
29:07 - 29:10
or that happen kind of younger or more frequently in people with HIV,
Dr. Bender Igancio
29:10 - 29:12
despite having good immune control over the virus.
Dr. Bálint Kacsoh
29:13 - 29:16
- How do you identify said patients to help?
Dr. Bálint Kacsoh
29:16 - 29:18
That seems like it's a really,
Dr. Bálint Kacsoh
29:19 - 29:20
there's a lot of people,
Dr. Bálint Kacsoh
29:20 - 29:22
a lot of people that need this help,
Dr. Bálint Kacsoh
29:22 - 29:22
right?
Dr. Bálint Kacsoh
29:22 - 29:26
It's not a small niche community by any stretch of the imagination,
Dr. Bálint Kacsoh
29:26 - 29:26
right?
Dr. Bálint Kacsoh
29:26 - 29:28
So how do you,
Dr. Bálint Kacsoh
29:28 - 29:28
I guess,
Dr. Bálint Kacsoh
29:29 - 29:29
first of all,
Dr. Bálint Kacsoh
29:29 - 29:30
get public buy-in,
Dr. Bálint Kacsoh
29:30 - 29:37
because some of these folks of marginalized people have undergone very questionable treatments in the past,
Dr. Bálint Kacsoh
29:37 - 29:37
right,
Dr. Bálint Kacsoh
29:37 - 29:39
when it comes to any kind of medical intervention,
Dr. Bálint Kacsoh
29:40 - 29:46
And then how do you ensure that you're hitting all these different populations to know that this is gonna work just in terms of the buy-in,
Dr. Bálint Kacsoh
29:46 - 29:47
not even yet the science of the drug?
Dr. Bender Igancio
29:49 - 29:50
- Yeah,
Dr. Bender Igancio
29:50 - 29:52
those are probably the most important questions,
Dr. Bender Igancio
29:52 - 29:54
more important than the science that we do itself.
Dr. Bender Igancio
29:57 - 30:01
So I belong to a network that's called ECTG,
Dr. Bender Igancio
30:02 - 30:06
advancing global therapeutics for HIV/AIDS and other infections,
Dr. Bender Igancio
30:07 - 30:08
and that's a global network.
Dr. Bender Igancio
30:08 - 30:13
We have a global community advisory board and we also have a local community advisory board in Seattle.
Dr. Bender Igancio
30:14 - 30:17
Our sister unit is the HIV vaccine trials unit.
Dr. Bender Igancio
30:18 - 30:19
That's also,
Dr. Bender Igancio
30:19 - 30:20
that's part of the Fred Hutch.
Dr. Bender Igancio
30:21 - 30:28
They're part of the HIV vaccine trials network with global community buy-in as well as a local cab or community advisory board.
Dr. Bender Igancio
30:29 - 30:30
And essentially,
Dr. Bender Igancio
30:30 - 30:34
HIV research has really set the standard for community buy-in.
Dr. Bender Igancio
30:34 - 30:38
I think a lot of other conditions now involve people being treated for those conditions,
Dr. Bender Igancio
30:39 - 30:40
other community stakeholders,
Dr. Bender Igancio
30:40 - 30:46
but it was really AIDS activists in the 80s and 90s who banged down the doors of the NIH and said,
Dr. Bender Igancio
30:47 - 30:49
"You're not finding us answers fast enough.
Dr. Bender Igancio
30:49 - 30:49
You're not doing this.
Speaker 1
30:49 - 30:50
You're not,
Speaker 1
30:50 - 30:51
you know,
Dr. Bender Igancio
30:51 - 30:56
a lot of people weren't getting access to trials or new medications because scientists said,
Dr. Bender Igancio
30:56 - 30:57
"This is too dangerous.
Dr. Bender Igancio
30:57 - 31:02
We're not giving it to people yet." And people who were living with or dying from HIV at that moment said,
Dr. Bender Igancio
31:02 - 31:02
"Well,
Dr. Bender Igancio
31:02 - 31:08
what about what we want and what about what we need?" So I think since that moment,
Dr. Bender Igancio
31:09 - 31:13
most HIV researchers have been really dedicated to partnering directly with community.
Dr. Bender Igancio
31:14 - 31:16
We always ask what people's priorities are,
Dr. Bender Igancio
31:17 - 31:18
what should we be researching?
Dr. Bender Igancio
31:18 - 31:28
I think that's why there's so much emphasis on aging because we have a big community of folks who've been living with HIV since the 80s and 90s and their HIV is treatment,
Dr. Bender Igancio
31:28 - 31:29
but they have treated,
Dr. Bender Igancio
31:29 - 31:32
but they have a medical list that's like two pages long.
Dr. Bender Igancio
31:32 - 31:33
And they say,
Dr. Bender Igancio
31:33 - 31:33
okay,
Dr. Bender Igancio
31:33 - 31:33
great,
Dr. Bender Igancio
31:33 - 31:36
I can treat my HIV with one pill once a day,
Dr. Bender Igancio
31:36 - 31:40
but what about all this other stuff I'm enduring that my friends without HIV don't have?
Speaker 1
31:40 - 31:40
So,
Dr. Bender Igancio
31:40 - 31:41
you know,
Dr. Bender Igancio
31:41 - 31:42
so we listen to the community.
Dr. Bender Igancio
31:43 - 31:51
We have a community advisory board meeting every month locally and we run all protocols or potential protocols by our community advisory board for input.
Dr. Bender Igancio
31:52 - 31:53
People tell us,
Dr. Bender Igancio
31:53 - 31:54
you know,
Dr. Bender Igancio
31:54 - 31:57
this seems too invasive or why are you doing this?
Dr. Bender Igancio
31:57 - 32:00
Or have you thought about asking these types of questions?
Dr. Bender Igancio
32:01 - 32:03
And then when we develop protocols,
Dr. Bender Igancio
32:03 - 32:09
We always have a community member on every single protocol on our data safety and monitoring boards.
Dr. Bender Igancio
32:09 - 32:12
So there's at least one person from the community,
Dr. Bender Igancio
32:12 - 32:17
someone who's either openly living with HIV or otherwise states that they're impacted by HIV,
Dr. Bender Igancio
32:17 - 32:23
weighing into the science with as much input on that protocol as any of the scientists or biostatisticians.
Dr. Bálint Kacsoh
32:26 - 32:28
- What is the role of said community member,
Dr. Bálint Kacsoh
32:28 - 32:29
like in terms of the weighing?
Dr. Bálint Kacsoh
32:29 - 32:30
'Cause like you said,
Dr. Bálint Kacsoh
32:30 - 32:31
that seems really,
Dr. Bálint Kacsoh
32:31 - 32:35
really important to have that buy in and to have members of said communities with a voice.
Dr. Bálint Kacsoh
32:36 - 32:38
And how do you balance it where it's like,
Dr. Bálint Kacsoh
32:38 - 32:38
you know,
Dr. Bálint Kacsoh
32:39 - 32:47
you're doing the science and you might see what's efficient and what might work in a patient versus also the balance of that buy in and then just the feasibility,
Dr. Bálint Kacsoh
32:48 - 32:48
right?
Dr. Bálint Kacsoh
32:48 - 32:51
'Cause you were saying that not everyone can take a pill every day,
Dr. Bálint Kacsoh
32:52 - 32:52
right?
Dr. Bálint Kacsoh
32:52 - 32:53
So how does,
Dr. Bálint Kacsoh
32:53 - 32:56
when you're getting the feedback from one side versus the other side,
Dr. Bálint Kacsoh
32:57 - 33:00
how do you pull those two things together and make it into a cohesive,
Dr. Bálint Kacsoh
33:01 - 33:01
almost treatment plan.
Dr. Bender Igancio
33:03 - 33:03
- Yeah,
Dr. Bender Igancio
33:03 - 33:04
I mean,
Dr. Bender Igancio
33:04 - 33:05
it's really challenging.
Dr. Bender Igancio
33:05 - 33:09
I think one of my other passions is how to figure out how to do clinical trials better.
Dr. Bender Igancio
33:10 - 33:22
And I sort of have been working on this idea and a paper that hopefully will be published soon called "What if Marie Kondo Wrote a Protocol?" Because what ends up happening is that we end up having 75 cooks in a kitchen.
Dr. Bender Igancio
33:22 - 33:23
And,
Dr. Bender Igancio
33:23 - 33:23
oh,
Dr. Bender Igancio
33:23 - 33:23
well,
Dr. Bender Igancio
33:23 - 33:25
what about adding this survey to ask people,
Dr. Bender Igancio
33:26 - 33:28
how their experience of this new product is?
Dr. Bender Igancio
33:28 - 33:32
What if we collect some cells to study this other thing?
Dr. Bender Igancio
33:32 - 33:33
What if we,
Dr. Bender Igancio
33:33 - 33:34
what if we,
Dr. Bender Igancio
33:34 - 33:34
what if we?
Dr. Bender Igancio
33:34 - 33:44
And you end up with this cluttered thing that's so impossible that it actually is so burdensome for the person to participate that they almost can't unless they don't have a job.
Dr. Bender Igancio
33:45 - 33:52
And it's so burdensome for our research center to do to have all of those steps.
Dr. Bender Igancio
33:52 - 33:53
That said,
Dr. Bender Igancio
33:53 - 33:59
a lot of that kind of weight of what gets built into a protocol is for safety and for ethics.
Dr. Bender Igancio
34:00 - 34:06
I'm glad you brought up the obviously marginalized populations who are disproportionately impacted by HIV or also those who've had,
Dr. Bender Igancio
34:06 - 34:07
in many cases,
Dr. Bender Igancio
34:07 - 34:08
the worst experience with science,
Dr. Bender Igancio
34:08 - 34:09
with medical care.
Dr. Bender Igancio
34:10 - 34:15
And so every protocol also has layer upon layer of safety and ethics reviews.
Dr. Bender Igancio
34:17 - 34:20
And that's part of what the community member also does.
Dr. Bender Igancio
34:20 - 34:23
They read our consent forms before they're finalized.
Dr. Bender Igancio
34:23 - 34:24
They make sure they're understandable.
Dr. Bender Igancio
34:25 - 34:29
They make sure that having read the protocol the science having read,
Speaker 1
34:29 - 34:29
you know,
Dr. Bender Igancio
34:29 - 34:31
if we're going to give somebody a medication,
Dr. Bender Igancio
34:32 - 34:34
whether it's already approved or investigational,
Dr. Bender Igancio
34:35 - 34:38
that we're adequately reflecting the risks that they may face,
Dr. Bender Igancio
34:38 - 34:41
adequately reflecting the benefits that they make,
Dr. Bender Igancio
34:41 - 34:43
the person participating may get or saying,
Dr. Bender Igancio
34:43 - 34:43
you know,
Dr. Bender Igancio
34:44 - 34:45
you might not get any benefit,
Dr. Bender Igancio
34:45 - 34:45
but science,
Dr. Bender Igancio
34:46 - 34:47
other people may get the benefit.
Dr. Bender Igancio
34:47 - 34:49
And so just really weighing into all of that,
Dr. Bender Igancio
34:50 - 35:03
making sure that the kind of we're balancing the amount of information that we want to learn from a study versus is what would be reasonable to ask a person to undergo in the name of either improving their own health or just altruistically for science?
Dr. Bálint Kacsoh
35:04 - 35:09
- What is a reasonable thing to ask someone when doing a clinical trial?
Dr. Bálint Kacsoh
35:09 - 35:13
I think we don't usually get exposed to these clinical trials,
Dr. Bálint Kacsoh
35:13 - 35:13
right?
Dr. Bálint Kacsoh
35:13 - 35:15
And you're like in the dredges of it.
Dr. Bálint Kacsoh
35:15 - 35:15
You're doing it,
Dr. Bálint Kacsoh
35:15 - 35:17
you're running the experiments,
Dr. Bálint Kacsoh
35:17 - 35:18
you design the drug,
Dr. Bálint Kacsoh
35:18 - 35:18
right?
Dr. Bálint Kacsoh
35:19 - 35:22
What exactly is reasonable to ask a patient?
Dr. Bálint Kacsoh
35:23 - 35:27
And I guess what would be your dream scenario of what you could ask for?
Dr. Bálint Kacsoh
35:27 - 35:28
What is reasonable?
Dr. Bálint Kacsoh
35:29 - 35:34
And are those differences exacerbated by different communities and different backgrounds,
Dr. Bálint Kacsoh
35:34 - 35:34
right?
Dr. Bálint Kacsoh
35:34 - 35:40
So are there some communities that you really wanna help that some of the questions that you wanna ask are just like,
Dr. Bálint Kacsoh
35:40 - 35:43
this is gonna be too much and vice versa on others?
Dr. Bálint Kacsoh
35:43 - 35:43
Like,
Dr. Bálint Kacsoh
35:44 - 35:49
it just seems like a logistical nightmare and the fact that y'all can help people is huge just to begin with,
Speaker 1
35:49 - 35:50
right?
Dr. Bender Igancio
35:51 - 35:51
- Yeah,
Dr. Bender Igancio
35:51 - 35:56
so I think the kind of short answer to that I'll give first,
Dr. Bender Igancio
35:56 - 35:57
I know I don't give short answers.
Dr. Bender Igancio
35:57 - 36:03
The short answer is that there's not a one size fits all thing that you can ask of people.
Dr. Bender Igancio
36:03 - 36:10
What you ask of people is sort of proportionate to what they're experiencing from their condition,
Dr. Bender Igancio
36:10 - 36:12
as well as,
Dr. Bender Igancio
36:12 - 36:13
you know,
Dr. Bender Igancio
36:13 - 36:18
sort of how intense the research needs to be to answer the question.
Dr. Bender Igancio
36:18 - 36:23
And I think what we're trying to figure out right now a little bit is how to right size that.
Dr. Bender Igancio
36:24 - 36:38
So we want to have the highest amount of safety controls and information learned from a study in which we're studying HIV reservoirs and trying to work for a cure.
Speaker 1
36:38 - 36:39
For those studies,
Dr. Bender Igancio
36:40 - 36:43
we're usually asking people who have well-controlled HIV,
Dr. Bender Igancio
36:44 - 36:47
who know a lot about their health condition,
Dr. Bender Igancio
36:47 - 36:50
who really are interested in the science of it,
Dr. Bender Igancio
36:50 - 36:54
who in some cases have been sort of thinking about it and reading about it,
Dr. Bender Igancio
36:54 - 37:03
sign up for doing something extremely intense that they know that they might not actually get any benefit from,
Dr. Bender Igancio
37:03 - 37:11
but will be helping somebody in the future potentially be cured of HIV or to be able to have their immune system take care of HIV without treatment.
Dr. Bender Igancio
37:12 - 37:12
On the flip side,
Dr. Bender Igancio
37:12 - 37:15
when we do something like implementation science,
Dr. Bender Igancio
37:15 - 37:26
which means taking something that we know works in the ideal perfect population and trying to see how do we get it to new populations or how do we get it out into the clinic.
Dr. Bender Igancio
37:27 - 37:27
Those studies,
Dr. Bender Igancio
37:28 - 37:32
we want to be very light touch and ask almost nothing of the person.
Dr. Bender Igancio
37:32 - 37:34
We want them to know that they're in a study.
Dr. Bender Igancio
37:35 - 37:37
We want them to consent to being in the study.
Dr. Bender Igancio
37:37 - 37:43
And otherwise we want to sort of mess with reality as little as possible.
Dr. Bender Igancio
37:45 - 37:46
Otherwise you have the Hawthorne effect,
Dr. Bender Igancio
37:47 - 37:47
right?
Dr. Bender Igancio
37:47 - 37:49
because you're watching it so it changes.
Dr. Bender Igancio
37:50 - 37:57
So we really kind of vary that risk and that intensity based on the question that we're trying to answer.
Dr. Bálint Kacsoh
37:57 - 37:57
- Cool,
Dr. Bálint Kacsoh
37:58 - 37:58
so it's,
Dr. Bálint Kacsoh
37:59 - 37:59
again,
Dr. Bálint Kacsoh
37:59 - 38:02
a lot of that personalized medicine,
Dr. Bálint Kacsoh
38:02 - 38:05
but now a personalized almost clinical trial,
Dr. Bálint Kacsoh
38:06 - 38:06
right?
Dr. Bálint Kacsoh
38:06 - 38:06
Where it's like,
Dr. Bálint Kacsoh
38:07 - 38:09
you have to be very aware of the patient that you're pulling in,
Dr. Bálint Kacsoh
38:09 - 38:10
what you can ask,
Dr. Bálint Kacsoh
38:10 - 38:10
how you can ask,
Dr. Bálint Kacsoh
38:10 - 38:12
and how that's gonna inform your research question.
Dr. Bender Igancio
38:14 - 38:14
- Absolutely,
Dr. Bender Igancio
38:14 - 38:15
absolutely.
Dr. Bender Igancio
38:15 - 38:22
And for studies that are focused on answering a question that's specifically like for folks who are having a challenge taking their medication,
Dr. Bender Igancio
38:23 - 38:27
we're specifically looking for populations of people who are often using substances,
Dr. Bender Igancio
38:28 - 38:29
may have unstable housing.
Dr. Bender Igancio
38:30 - 38:31
For those types of studies,
Dr. Bender Igancio
38:32 - 38:37
our minimum standard is we need a way to get a hold of you and you may not own a cell phone,
Dr. Bender Igancio
38:37 - 38:40
but you need to have some way that you can check in with us,
Dr. Bender Igancio
38:40 - 38:41
a case manager,
Dr. Bender Igancio
38:41 - 38:42
if you give us,
Dr. Bender Igancio
38:42 - 38:43
you know,
Dr. Bender Igancio
38:43 - 38:45
permission to contact on your behalf,
Dr. Bender Igancio
38:45 - 38:47
a place we can leave messages with.
Dr. Bender Igancio
38:48 - 38:56
And we want that study to be as light touch as possible because we're trying to design an intervention for people who are having a hard time sticking with medical care.
Dr. Bálint Kacsoh
38:57 - 38:59
- So let's get into,
Dr. Bálint Kacsoh
38:59 - 39:02
we have a lot of questions coming in from like the drug trials perspective on its own,
Dr. Bálint Kacsoh
39:02 - 39:08
but let's get into a little bit of like the science behind what is the new thing that you're trying to do?
Dr. Bálint Kacsoh
39:08 - 39:09
So what is,
Dr. Bálint Kacsoh
39:09 - 39:13
what is the new treatment's goal that you are trying to take,
Dr. Bálint Kacsoh
39:13 - 39:17
like we touched a little bit on it's like not daily taking of the drug.
Dr. Bálint Kacsoh
39:18 - 39:19
What is the new thing trying to do?
Dr. Bálint Kacsoh
39:19 - 39:21
Like what is different about it?
Dr. Bender Igancio
39:22 - 39:23
- What is different about it?
Dr. Bender Igancio
39:23 - 39:30
So I think there's a couple of different angles on long acting HIV treatment and prevention.
Dr. Bender Igancio
39:31 - 39:32
I'll kind of go across the spectrum.
Dr. Bender Igancio
39:33 - 39:51
And that I think a lot of what is converging in HIV immunology and in treatment is this idea that HIV prevention and treatment are looking a lot more like each other and HIV cure and vaccinology or HIV prevention are kind of looking a lot more like each other.
Dr. Bender Igancio
39:51 - 39:57
So in some ways our research is asking very similar questions in the prevention and in the cure realm.
Dr. Bender Igancio
39:58 - 40:04
So there's sort of two buckets of making a treatment or prevention longer acting.
Dr. Bender Igancio
40:04 - 40:09
One could just be a new mechanism of getting it to be distributed in the body.
Dr. Bender Igancio
40:09 - 40:12
So we've got long acting medications that everybody's familiar with,
Dr. Bender Igancio
40:12 - 40:14
like Depo Provera,
Dr. Bender Igancio
40:14 - 40:16
birth control that is a shot that lasts three months,
Dr. Bender Igancio
40:17 - 40:18
or a Nuva Ring,
Dr. Bender Igancio
40:18 - 40:19
or something like that.
Dr. Bender Igancio
40:19 - 40:21
I'm saying the brand names 'cause that's what people know.
Speaker 1
40:22 - 40:22
But,
Dr. Bender Igancio
40:24 - 40:26
and there's long acting psychiatric medications and things like that.
Dr. Bender Igancio
40:27 - 40:34
So those are just pharmacologic innovations or sort of new ways to deliver probably the same drugs,
Dr. Bender Igancio
40:35 - 40:42
or similar types of drugs that aren't really thinking differently about how to treat or cure HIV differently.
Dr. Bender Igancio
40:43 - 40:46
But some of the prevention and cure techniques that are sort of,
Dr. Bender Igancio
40:46 - 40:46
again,
Dr. Bender Igancio
40:46 - 40:49
kind of converging is new immunology,
Dr. Bender Igancio
40:50 - 40:57
which is working on ways to either teach our immune system how to respond more effectively or give us passive immunity.
Dr. Bender Igancio
40:57 - 41:01
So passive immunity is getting an infusion of antibodies.
Dr. Bender Igancio
41:02 - 41:03
We learned about this a lot,
Dr. Bender Igancio
41:03 - 41:04
or I mean,
Dr. Bender Igancio
41:04 - 41:10
I think maybe the public learned about this a lot during COVID with a lot of the COVID treatments that were these monoclonal antibody infusions,
Dr. Bender Igancio
41:10 - 41:14
so synthetic antibodies that were used to either treat or prevent COVID.
Dr. Bender Igancio
41:15 - 41:16
Actually,
Dr. Bender Igancio
41:16 - 41:17
all of that science,
Dr. Bender Igancio
41:17 - 41:18
I won't say all,
Dr. Bender Igancio
41:18 - 41:29
but a lot of that science came out of HIV science where we've been working to put together these broadly neutralizing antibodies for either HIV prevention or HIV treatment or cure.
Dr. Bender Igancio
41:30 - 41:33
And sort of in this cure realm,
Dr. Bender Igancio
41:33 - 41:35
what we're seeing is that,
Speaker 1
41:35 - 41:36
you know,
Dr. Bender Igancio
41:36 - 41:39
people have different goals for what cure means for them.
Dr. Bender Igancio
41:39 - 41:44
Some people need to test HIV negative or have HIV eradicated from their body where they never see it again.
Dr. Bender Igancio
41:44 - 41:47
And other people just need to not take a medication every day.
Dr. Bender Igancio
41:48 - 41:53
So long acting treatments and HIV remission from kind of an immunologic standpoint,
Dr. Bender Igancio
41:53 - 41:58
meaning maybe giving somebody intermittent infusions to boost their immunity or to give us passive immunity,
Dr. Bender Igancio
41:59 - 42:00
sort of functionally do the same thing,
Dr. Bender Igancio
42:00 - 42:01
which means that,
Dr. Bender Igancio
42:01 - 42:02
you know,
Dr. Bender Igancio
42:02 - 42:11
maybe we have a future pretty soon where somebody could get a couple of infusions or a couple of injections per year and not have to take daily medication.
Dr. Bender Igancio
42:11 - 42:24
And that can be either kind of via the classic HIV medication delivered differently or via these sort of novel immune approaches that keep the HIV under control without treatment for a longer period of time.
Dr. Bálint Kacsoh
42:25 - 42:25
- That's really cool.
Dr. Bálint Kacsoh
42:25 - 42:29
So you're going down several routes to try to get at the same answer,
Dr. Bálint Kacsoh
42:29 - 42:29
right?
Dr. Bálint Kacsoh
42:29 - 42:32
of repackaging existing things to last longer,
Dr. Bálint Kacsoh
42:33 - 42:33
right?
Dr. Bálint Kacsoh
42:33 - 42:36
Based on mechanisms that we already know how they work,
Dr. Bálint Kacsoh
42:36 - 42:37
you're just now repurposing,
Dr. Bálint Kacsoh
42:37 - 42:37
right,
Dr. Bálint Kacsoh
42:37 - 42:38
of remaking,
Dr. Bálint Kacsoh
42:38 - 42:40
and then novel techniques as well,
Dr. Bálint Kacsoh
42:40 - 42:41
and just pushing forth both.
Dr. Bálint Kacsoh
42:43 - 42:43
And with the end,
Dr. Bálint Kacsoh
42:43 - 42:44
I hope,
Dr. Bálint Kacsoh
42:44 - 42:44
right,
Dr. Bálint Kacsoh
42:44 - 42:45
everything works,
Dr. Bálint Kacsoh
42:45 - 42:46
but if one doesn't pan out,
Dr. Bálint Kacsoh
42:46 - 42:47
you've got the other one that's going.
Dr. Bender Igancio
42:48 - 42:48
- Right.
Dr. Bender Igancio
42:49 - 42:56
And there's even been some recently completed clinical trials in which people can get maybe one or two infusions of a BNAB,
Dr. Bender Igancio
42:56 - 43:04
one of these neutralizing antibody plus a long-acting HIV injectable medication every six months.
Dr. Bender Igancio
43:04 - 43:09
And so the two of those things put together could equal that person's HIV treatment.
Dr. Bender Igancio
43:10 - 43:12
So a little mix and match there.
Dr. Bender Igancio
43:12 - 43:14
And the same thing for prevention.
Dr. Bender Igancio
43:14 - 43:15
Generally,
Dr. Bender Igancio
43:15 - 43:18
we need less medication to prevent than we do to treat,
Dr. Bender Igancio
43:19 - 43:22
sort of a general principle throughout medicine.
Dr. Bender Igancio
43:22 - 43:29
But both of these kind of immunologic and long-acting medications medications are going into the prevention realm as well.
Dr. Bálint Kacsoh
43:30 - 43:30
What does,
Dr. Bálint Kacsoh
43:30 - 43:34
so what phase drug trial are you working on now?
Dr. Bálint Kacsoh
43:34 - 43:36
And how does one progress,
Dr. Bálint Kacsoh
43:36 - 43:39
I think what you said mentioned it was phase two clinical trials currently.
Dr. Bálint Kacsoh
43:40 - 43:43
How does something like that be progressed?
Dr. Bálint Kacsoh
43:43 - 43:58
So Chat was wondering like what does a result look like for you where you're like okay this is safe for x person or x number of people and then now you can progress to a a larger population size or testing it on now individuals that aren't as healthy.
Dr. Bálint Kacsoh
43:58 - 44:02
Where do you make that fine decision of what the next step is?
Dr. Bender Igancio
44:04 - 44:04
- Yeah,
Dr. Bender Igancio
44:04 - 44:04
so,
Dr. Bender Igancio
44:05 - 44:05
you know,
Dr. Bender Igancio
44:05 - 44:12
we have fewer clinical trials going right now than we do in a normal year because 2025 is not a normal scientific year,
Dr. Bender Igancio
44:12 - 44:13
as all of us know,
Dr. Bender Igancio
44:13 - 44:18
but we often have 15 to 20 trials open at our research center at any point in time.
Dr. Bender Igancio
44:19 - 44:21
And those can actually span all the way from first in human,
Dr. Bender Igancio
44:22 - 44:30
meaning that this is the very first human who's ever gotten this medication after it having been tested in macaques and in vehicles,
Dr. Bender Igancio
44:30 - 44:31
and then it goes into people.
Dr. Bender Igancio
44:32 - 44:35
So we recently completed at our center,
Dr. Bender Igancio
44:36 - 44:43
first in human study of a novel nanoparticle HIV delivery system.
Dr. Bender Igancio
44:44 - 44:46
And then we have everything from there to phase four,
Dr. Bender Igancio
44:46 - 44:51
meaning it's already approved and we're looking at it in a new light we're looking at it for a new population.
Dr. Bender Igancio
44:52 - 44:55
And I think the key thing is that I never make these decisions by myself.
Dr. Bender Igancio
44:56 - 44:59
So I think all of this is team science.
Dr. Bender Igancio
45:00 - 45:01
It's never me saying,
Dr. Bender Igancio
45:01 - 45:01
okay,
Dr. Bender Igancio
45:01 - 45:03
I think I'm ready to put this into phase two.
Dr. Bender Igancio
45:05 - 45:26
This is all very carefully thought about at each stage from usually a data safety and monitoring board who's looking at the results results in near real time to make sure that the people who are on that study are safe and that they're having effect.
Dr. Bender Igancio
45:28 - 45:29
If that's the intention is that,
Dr. Bender Igancio
45:29 - 45:29
you know,
Dr. Bender Igancio
45:29 - 45:32
to be able to find out effect in this in the studies.
Dr. Bender Igancio
45:34 - 45:38
And then each phase is also approved by the FDA as well if it's a new drug.
Dr. Bender Igancio
45:38 - 45:40
So there are many,
Dr. Bender Igancio
45:40 - 45:42
many layers of people looking at this,
Dr. Bender Igancio
45:43 - 45:48
starting with biostatisticians to to make sure we're using exactly the right number of people in a study,
Dr. Bender Igancio
45:48 - 45:52
because we don't wanna have too small of a study where we can't answer the question,
Dr. Bender Igancio
45:52 - 45:55
but we also don't wanna enroll a single person more than we need,
Dr. Bender Igancio
45:56 - 45:58
because that's extra risk to that person,
Dr. Bender Igancio
45:58 - 46:00
that's extra time and money wasted.
Dr. Bender Igancio
46:04 - 46:06
So biostatistician helps us right size it,
Dr. Bender Igancio
46:06 - 46:11
helps us make sure that we're answering the correct question and measuring the outcomes in the right way.
Dr. Bender Igancio
46:12 - 46:12
Again,
Dr. Bender Igancio
46:12 - 46:14
ethics folks involved,
Dr. Bender Igancio
46:14 - 46:15
community members involved,
Dr. Bender Igancio
46:16 - 46:17
virologists,
Dr. Bender Igancio
46:17 - 46:17
immunologists,
Speaker 1
46:19 - 46:19
many,
Dr. Bender Igancio
46:19 - 46:20
many ologists,
Dr. Bender Igancio
46:20 - 46:23
cardiologists for some of our research.
Dr. Bender Igancio
46:24 - 46:27
And then at the end of each study,
Dr. Bender Igancio
46:28 - 46:30
our results are posted on clinicaltrials.gov,
Dr. Bender Igancio
46:30 - 46:32
so everything is publicly available.
Dr. Bender Igancio
46:33 - 46:35
Whether or not there is a manuscript published in a journal,
Dr. Bender Igancio
46:36 - 46:37
which were obligated to do,
Dr. Bender Igancio
46:37 - 46:39
but may take some time,
Dr. Bender Igancio
46:39 - 46:42
but within one year of that last person exiting the trial,
Dr. Bender Igancio
46:42 - 46:45
or required to put the results up on a publicly available website.
Dr. Bender Igancio
46:46 - 46:47
We have to report to the FDA.
Dr. Bender Igancio
46:48 - 46:49
We have to report to our ethics boards.
Dr. Bender Igancio
46:51 - 46:55
So there's a number of checks and then generally a big group decision that says,
Dr. Bender Igancio
46:55 - 46:56
okay,
Dr. Bender Igancio
46:56 - 47:03
we're ready to move it to the next phase or we're ready to create an application to the FDA for approval of a new drug,
Dr. Bender Igancio
47:04 - 47:05
which is generally not me.
Dr. Bender Igancio
47:05 - 47:11
It's generally at that point as a company or it may be a university,
Dr. Bender Igancio
47:11 - 47:11
for example.
Dr. Bálint Kacsoh
47:12 - 47:15
So which of the stages are you most involved?
Dr. Bálint Kacsoh
47:16 - 47:18
You mentioned that there are stages where there's macaques involved,
Dr. Bálint Kacsoh
47:18 - 47:19
the macaque testing.
Dr. Bálint Kacsoh
47:20 - 47:23
And then I believe phase one is when you're testing on healthy individuals,
Dr. Bálint Kacsoh
47:24 - 47:24
right,
Dr. Bálint Kacsoh
47:24 - 47:25
for getting dose responses.
Dr. Bálint Kacsoh
47:26 - 47:30
Which one of those are you involved in or do you get to do all of those?
Dr. Bender Igancio
47:30 - 47:31
- I get to do all of it,
Dr. Bender Igancio
47:31 - 47:33
which is so fun.
Dr. Bender Igancio
47:34 - 47:36
For our first in human study,
Dr. Bender Igancio
47:36 - 47:44
it's important to look at the data from the macaques and make sure that we think that the drug long acting enough to make sure that it's safe enough in those animals.
Dr. Bender Igancio
47:45 - 47:46
The FDA recently,
Dr. Bender Igancio
47:46 - 47:47
for one of our,
Dr. Bender Igancio
47:48 - 47:52
one of these compounds said,
Dr. Bender Igancio
47:52 - 47:52
you know,
Dr. Bender Igancio
47:52 - 47:53
looks great in macaques,
Dr. Bender Igancio
47:54 - 47:57
but we know that beagles are more sensitive than monkeys are immunologically.
Dr. Bender Igancio
47:58 - 47:59
And if there's going to be a reaction,
Dr. Bender Igancio
48:00 - 48:01
we want to know about it.
Dr. Bender Igancio
48:01 - 48:02
So let's,
Dr. Bender Igancio
48:02 - 48:12
let's test it in a second species or and that's actually a third species because most things start in mice or rats before they they go on to macaques or to dogs.
Dr. Bender Igancio
48:12 - 48:14
And then we look at the safety,
Dr. Bender Igancio
48:14 - 48:16
we look at all of that before we look at the human data.
Dr. Bender Igancio
48:16 - 48:19
So I don't do any of the experimentation with monkeys myself,
Dr. Bender Igancio
48:19 - 48:21
but I wanna look at that,
Dr. Bender Igancio
48:21 - 48:26
we call it NHP non-human primate data before we do anything with people.
Dr. Bender Igancio
48:27 - 48:28
And then yeah,
Dr. Bender Igancio
48:28 - 48:35
we get to do everything from the very first injection ever in a human all the way up to here's something that's approved.
Dr. Bender Igancio
48:36 - 48:38
And we just wanna answer a different,
Dr. Bender Igancio
48:38 - 48:41
see if this drug answers a different question or maybe a new use case.
Dr. Bálint Kacsoh
48:42 - 48:43
- And in that instance,
Dr. Bálint Kacsoh
48:43 - 48:45
it's something that's already gone through safety testing.
Dr. Bálint Kacsoh
48:45 - 48:46
You're just kind of using it for,
Dr. Bálint Kacsoh
48:47 - 48:47
I guess,
Dr. Bálint Kacsoh
48:48 - 48:50
basically to see if there's a side effect that could help someone,
Dr. Bálint Kacsoh
48:50 - 48:51
right?
Dr. Bálint Kacsoh
48:51 - 48:55
Like if there's a side effect that's now a treatment in another case.
Dr. Bálint Kacsoh
48:55 - 48:57
Is that a kind of a fair way to put it?
Dr. Bender Igancio
48:58 - 48:59
- In some cases,
Dr. Bender Igancio
48:59 - 49:00
in some cases,
Dr. Bender Igancio
49:00 - 49:06
I think that that's very common with immunologic drugs or some of these kind of more broad medications.
Dr. Bender Igancio
49:06 - 49:06
So for example,
Dr. Bender Igancio
49:07 - 49:11
we recently concluded a study with a drug called nalfinivir,
Dr. Bender Igancio
49:11 - 49:15
which is an old protease inhibitor for HIV that we don't use clinically anymore,
Dr. Bender Igancio
49:16 - 49:20
both because it's too weak and it also has a lot of side effects.
Dr. Bender Igancio
49:20 - 49:25
But it turns out that some of those side effects are on mitochondria,
Dr. Bender Igancio
49:25 - 49:27
they're on our T-cell cycling,
Dr. Bender Igancio
49:27 - 49:31
they're involved kind of getting into the machinery inside of a T-cell.
Dr. Bender Igancio
49:32 - 49:38
So taking that medication in high dose for a very long time didn't work so well for HIV.
Dr. Bender Igancio
49:40 - 49:43
But when you think about it for Kaposi sarcoma,
Dr. Bender Igancio
49:43 - 49:44
which is what we were using it for,
Dr. Bender Igancio
49:46 - 49:50
we can tolerate a lot more side effects for chemotherapy,
Dr. Bender Igancio
49:50 - 49:52
because if we're taking something that's sort of like,
Dr. Bender Igancio
49:52 - 49:56
it wasn't a great HIV medication because it has too many off-target effects,
Dr. Bender Igancio
49:57 - 50:10
but those off-target effects are way less toxic and then get taking cytotoxic chemotherapy and someone's only gonna take it for eight weeks or 12 weeks and they have a condition that currently doesn't have a great treatment like Kaposi's sarcoma,
Dr. Bender Igancio
50:11 - 50:14
we are willing to look at that side effect profile very differently,
Dr. Bender Igancio
50:15 - 50:23
especially when those off-target effects are sort of impeding our cellular function in a way that we think might get in the way of the tumor,
Speaker 1
50:25 - 50:25
the tumor growth.
Dr. Bálint Kacsoh
50:26 - 50:30
- So I think one thing that people maybe aren't aware of the importance of this research,
Dr. Bálint Kacsoh
50:30 - 50:32
not just for the direct question that you're asking,
Dr. Bálint Kacsoh
50:33 - 50:36
but also the side rabbit holes that you're going to be able to answer,
Dr. Bálint Kacsoh
50:36 - 50:36
right?
Dr. Bálint Kacsoh
50:36 - 50:39
It's like in basic fundamental science,
Dr. Bálint Kacsoh
50:39 - 50:46
studying a jellyfish protein GFP got you now a molecular tool that everyone uses that's like revolutionized the field,
Dr. Bálint Kacsoh
50:46 - 50:47
right?
Dr. Bender Igancio
50:47 - 50:48
But including for HIV science.
Speaker 1
50:49 - 50:49
Right.
Dr. Bálint Kacsoh
50:49 - 50:50
And then you as well now,
Dr. Bálint Kacsoh
50:50 - 50:52
so you're in like treating HIV,
Dr. Bálint Kacsoh
50:53 - 50:58
but you can find something that could help in cancer or in any one of these other diseases.
Dr. Bálint Kacsoh
50:59 - 51:12
Could you talk a little bit about one of these serendipitous moments where it kind of-- you're looking at one treatment and it turns out it could help in something totally different and kind of tying it back to why then this is important to fun.
Dr. Bálint Kacsoh
51:12 - 51:13
Like you mentioned,
Dr. Bálint Kacsoh
51:13 - 51:16
it's been an off year for research for many of people,
Dr. Bálint Kacsoh
51:16 - 51:16
right?
Dr. Bálint Kacsoh
51:17 - 51:20
We just got an anonymous $50 donation.
Dr. Bálint Kacsoh
51:20 - 51:22
These things add up and can make a difference.
Dr. Bálint Kacsoh
51:22 - 51:26
I think it's really highlighting that it's not just for people with HIV/AIDS,
Dr. Bálint Kacsoh
51:26 - 51:29
but you could be helping people across the board,
Dr. Bálint Kacsoh
51:30 - 51:30
you know,
Dr. Bálint Kacsoh
51:31 - 51:33
who've never been touched by this in any way.
Speaker 1
51:33 - 51:33
Right.
Speaker 1
51:34 - 51:34
Right.
Dr. Bender Igancio
51:35 - 51:41
So I would say it's maybe a little bit less common that the medication itself has off-target impacts.
Dr. Bender Igancio
51:41 - 51:46
I would say it's really the immunology and the virology that probably impacts other diseases the most.
Dr. Bender Igancio
51:47 - 51:51
A couple of good examples are that in understanding,
Dr. Bender Igancio
51:51 - 52:01
when I said that people who are taking their HIV medication well have almost normal immune systems with that kind of asterisk.
Dr. Bender Igancio
52:01 - 52:08
The asterisk is that people with HIV still have what we call kind of more of an exhausted phenotype to their cells,
Dr. Bender Igancio
52:08 - 52:23
which means that some of their T cells are kind of tired from trying to fight HIV all of the time and then may not be as effective at spitting out toxic chemicals or going around and killing other viruses or other things.
Dr. Bender Igancio
52:23 - 52:24
And it turns out,
Dr. Bender Igancio
52:24 - 52:25
or tumors.
Dr. Bender Igancio
52:26 - 52:37
And so some of these molecules that people discovered in looking at this phenomenon called immuno-exhaustion with HIV are checkpoint molecules.
Dr. Bender Igancio
52:37 - 52:39
And checkpoint molecules,
Dr. Bender Igancio
52:39 - 52:43
it turns out that when you block them by giving a checkpoint inhibitor,
Dr. Bender Igancio
52:44 - 52:47
are some of these medications like Pembrolizumab or Nivolumab,
Dr. Bender Igancio
52:48 - 52:56
which have just completely revolutionized cancer treatment for a wide variety of cancers over the last 20 years.
Dr. Bender Igancio
52:56 - 52:58
So for a lot of medications,
Dr. Bender Igancio
52:58 - 52:59
when people are taking,
Dr. Bender Igancio
53:00 - 53:01
or a lot of cancers,
Dr. Bender Igancio
53:02 - 53:10
people are now using kind of more immune therapy than sort of the standard cytotoxic chemotherapy that just blasts all of their cells.
Dr. Bender Igancio
53:10 - 53:22
A lot of these nuances in understanding the immune system and where to actually tackle cancer came from really our understanding of the immune system with HIV.
Dr. Bender Igancio
53:23 - 53:27
I think that's true for chimeric antigen receptor T cells,
Dr. Bender Igancio
53:27 - 53:28
so CAR T cells,
Dr. Bender Igancio
53:29 - 53:29
gene therapy.
Dr. Bender Igancio
53:30 - 53:31
A lot of these things are kind of,
Dr. Bender Igancio
53:31 - 53:32
you know,
Dr. Bender Igancio
53:32 - 53:34
people have been really working on them for HIV.
Dr. Bender Igancio
53:35 - 53:38
And gene therapy is,
Dr. Bender Igancio
53:38 - 53:38
I think,
Dr. Bender Igancio
53:38 - 53:42
working first for sickle cell disease and for other things like that.
Dr. Bender Igancio
53:42 - 53:42
but again,
Dr. Bender Igancio
53:42 - 53:47
a lot of this work has sort of been coming out over the decades with HIV.
Dr. Bender Igancio
53:48 - 53:50
In terms of sort of off-target effects,
Dr. Bender Igancio
53:53 - 53:54
what we're also seeing are things like,
Dr. Bender Igancio
53:55 - 53:57
people that are taking Paxovid for COVID,
Dr. Bender Igancio
53:58 - 53:59
that medication,
Dr. Bender Igancio
53:59 - 54:02
nirmetrovir doesn't last very long at all,
Dr. Bender Igancio
54:02 - 54:10
and so you can make it last long enough to just have to take the medication twice a day by pairing it with Ritranovir,
Dr. Bender Igancio
54:10 - 54:16
which is an old school HIV medication that kind of makes our liver not process it so fast.
Dr. Bender Igancio
54:16 - 54:18
So that's specifically an HIV medication,
Dr. Bender Igancio
54:19 - 54:29
but really probably I'm only overstating it a little bit to say that the speed with which we were able to find vaccines and treatments for COVID was really,
Dr. Bender Igancio
54:29 - 54:36
really from the foundational research that has been done in vaccinology and immunology and in virology for HIV.
Dr. Bender Igancio
54:36 - 54:38
And importantly,
Dr. Bender Igancio
54:38 - 54:42
I think having these big networks that are up at the ready,
Dr. Bender Igancio
54:42 - 54:53
the HIV vaccine trials network and the ECTG and others who have that infrastructure and folks like my colleagues who know how to run clinical trials that when we needed to do a COVID clinical trial,
Dr. Bender Igancio
54:53 - 54:54
we're all standing there,
Dr. Bender Igancio
54:54 - 54:55
we're all ready,
Dr. Bender Igancio
54:55 - 54:56
we're all trained,
Dr. Bender Igancio
54:56 - 54:57
we all know how to do this,
Dr. Bender Igancio
54:57 - 54:59
we just had to switch pathogens really quick.
Dr. Bender Igancio
55:00 - 55:02
And we did that again for MPOCs.
Dr. Bender Igancio
55:02 - 55:09
So I think so many different ways that HIV science has really impacted a lot of different,
Dr. Bender Igancio
55:09 - 55:11
a lot of different other conditions.
Dr. Bálint Kacsoh
55:11 - 55:11
- See,
Dr. Bálint Kacsoh
55:12 - 55:13
that's a big thing to highlight as well,
Dr. Bálint Kacsoh
55:13 - 55:14
because a lot of people,
Dr. Bálint Kacsoh
55:14 - 55:14
right,
Dr. Bálint Kacsoh
55:14 - 55:14
were like,
Dr. Bálint Kacsoh
55:15 - 55:15
"Oh,
Dr. Bálint Kacsoh
55:15 - 55:16
the COVID vaccine came so quickly,
Dr. Bálint Kacsoh
55:17 - 55:18
and how could it have come so quickly?" And you're saying like,
Speaker 1
55:18 - 55:19
"Well,
Dr. Bálint Kacsoh
55:20 - 55:28
not really." Because the mechanism of how to cure and treat it and develop things we've been working on for a long time.
Dr. Bálint Kacsoh
55:28 - 55:29
And it's just like you said,
Dr. Bálint Kacsoh
55:29 - 55:30
you just switched the pathogen,
Dr. Bálint Kacsoh
55:31 - 55:32
did the same protocol,
Dr. Bálint Kacsoh
55:33 - 55:33
got the answer,
Dr. Bálint Kacsoh
55:34 - 55:34
switched right back.
Dr. Bálint Kacsoh
55:35 - 55:39
And that is kind of the remarkable nature of what it is that we do in science,
Dr. Bálint Kacsoh
55:39 - 55:42
that it's not just for a single disease state,
Dr. Bálint Kacsoh
55:43 - 55:48
that you're learning fundamental components of biology that you can apply to so many other things.
Dr. Bálint Kacsoh
55:48 - 55:49
And that goes really,
Dr. Bálint Kacsoh
55:49 - 55:50
really understated.
Dr. Bender Igancio
55:51 - 55:51
- Yeah,
Dr. Bender Igancio
55:52 - 55:52
I mean,
Dr. Bender Igancio
55:52 - 55:53
and even just,
Dr. Bender Igancio
55:53 - 55:53
again,
Dr. Bender Igancio
55:53 - 55:56
the idea of bringing it into a clinical trial,
Dr. Bender Igancio
55:56 - 55:58
having sites around the world,
Dr. Bender Igancio
55:59 - 56:00
like the HVTN,
Dr. Bender Igancio
56:01 - 56:01
again,
Dr. Bender Igancio
56:01 - 56:04
which is headquartered at the Fred Hutch in the ECTG,
Dr. Bender Igancio
56:04 - 56:07
which is now headquartered at the University of North Carolina,
Dr. Bender Igancio
56:07 - 56:10
but has a site here in Seattle and all across the world.
Dr. Bender Igancio
56:11 - 56:13
We have teams at the ready.
Dr. Bender Igancio
56:13 - 56:14
We had community,
Dr. Bender Igancio
56:15 - 56:16
we knew how to get community involvement.
Dr. Bender Igancio
56:16 - 56:25
We knew how to get involvement from all of the different types of people and how to just get the machine running so quickly because people have been doing this.
Dr. Bender Igancio
56:26 - 56:35
And our leaders of our networks who led the COVID efforts are the same people who were in the room when it happened with HIV in the early 80s,
Dr. Bender Igancio
56:35 - 56:37
including Tony Fauci,
Dr. Bender Igancio
56:38 - 56:39
or maybe even most importantly,
Dr. Bender Igancio
56:39 - 56:40
Tony Fauci.
Dr. Bálint Kacsoh
56:41 - 56:42
- Yeah,
Dr. Bálint Kacsoh
56:42 - 56:44
I really appreciate you mentioning that.
Dr. Bálint Kacsoh
56:44 - 56:44
And again,
Dr. Bálint Kacsoh
56:44 - 56:47
tying back to the importance of keeping these things funding,
Dr. Bálint Kacsoh
56:47 - 56:50
that it's not an isolated disease that you're treating,
Dr. Bálint Kacsoh
56:50 - 56:52
it's not just like you're funding cancer,
Dr. Bálint Kacsoh
56:52 - 56:53
you're funding HIV,
Dr. Bálint Kacsoh
56:53 - 56:57
these things are all as interdisciplinary as the science that you're doing,
Dr. Bálint Kacsoh
56:57 - 56:58
which is,
Dr. Bálint Kacsoh
56:58 - 57:07
can I just say how cool it is that you're getting data from like Reese's macaques one day and the next day you're looking at dog data and the next day you're looking at people data and just linking everything together.
Dr. Bálint Kacsoh
57:08 - 57:10
Like that's huge.
Dr. Bálint Kacsoh
57:10 - 57:14
That's an immense challenge to be able to be running on a day-to-day basis.
Dr. Bálint Kacsoh
57:14 - 57:20
But I bet also very rewarding to be able to see it throughout the lifespan of its development.
Dr. Bender Igancio
57:21 - 57:21
- Yeah,
Dr. Bender Igancio
57:21 - 57:24
it's so much fun and it's such a great challenge.
Dr. Bender Igancio
57:24 - 57:28
And I think one of the best things about being,
Dr. Bender Igancio
57:28 - 57:29
I wouldn't say I'm super senior,
Dr. Bender Igancio
57:30 - 57:31
but about being mid-career,
Dr. Bender Igancio
57:32 - 57:32
being more senior,
Dr. Bender Igancio
57:33 - 57:34
is that I have a number of colleagues,
Dr. Bender Igancio
57:34 - 57:41
a number of mentees who are working in areas that are more broad than I can work any day.
Dr. Bender Igancio
57:42 - 57:45
So I work with a fantastic epidemiologist,
Dr. Bender Igancio
57:46 - 57:47
PhD epidemiologist,
Dr. Bender Igancio
57:47 - 57:54
who has sort of taken on all of my cancer and HIV research that I started on as a post-doc and had to put down for a couple of years,
Dr. Bender Igancio
57:55 - 57:55
and is really working,
Dr. Bender Igancio
57:56 - 58:05
she's an epidemiologist an implementation scientist and has really grown that into her own and is really leading that and I collaborate with her and I check in with her and help mentor her,
Dr. Bender Igancio
58:05 - 58:07
but that's really her own.
Dr. Bender Igancio
58:07 - 58:25
Separately we're working on epidemiology and outcomes related to HIV with these big US data sets that have 20,000 people living with HIV and we can look at clinical outcomes through some pretty pure epidemiology in that way and I don't do all of my own analysis anymore,
Dr. Bender Igancio
58:26 - 58:29
but I have fantastic colleagues and mentees who can do that analysis.
Dr. Bender Igancio
58:29 - 58:32
And I can sit and brainstorm with them about how to ask the question,
Dr. Bender Igancio
58:32 - 58:33
how to avoid bias,
Dr. Bender Igancio
58:33 - 58:35
how do we measure something correctly?
Dr. Bender Igancio
58:36 - 58:37
But then,
Dr. Bender Igancio
58:37 - 58:37
you know,
Dr. Bender Igancio
58:37 - 58:49
ultimately we just have this really broad interdisciplinary team across a number of countries who can kind of take on each of these pieces because none of us have the expertise to do this on our own.
Dr. Bender Igancio
58:49 - 58:50
And that's really what team science is.
Dr. Bálint Kacsoh
58:52 - 58:55
- When looking at those kind of really large data sets from patients.
Dr. Bálint Kacsoh
58:56 - 59:00
How difficult is it to get answers from cross data sets,
Dr. Bálint Kacsoh
59:00 - 59:01
right?
Dr. Bálint Kacsoh
59:01 - 59:03
Because everyone is so different.
Dr. Bálint Kacsoh
59:04 - 59:08
You can't control a person like you can't a fruit fly and not just with the genetics,
Dr. Bálint Kacsoh
59:08 - 59:10
but right the temperature humidity diet.
Dr. Bálint Kacsoh
59:11 - 59:23
How do you account for all these variables that are present in people to then be able to make these informed decisions about these kinds of clinical trials or just even figuring out dosages or just any of the fundamentals?
Dr. Bender Igancio
59:25 - 59:25
- Yeah,
Dr. Bender Igancio
59:25 - 59:26
I think that's a great question.
Dr. Bender Igancio
59:26 - 59:27
I mean,
Dr. Bender Igancio
59:27 - 59:34
one of the key things is we asked completely different questions and we also work on our data sources.
Dr. Bender Igancio
59:34 - 59:41
So the Centers for AIDS Research is a big collaboration funded through the NIH and has sites across the country.
Dr. Bender Igancio
59:42 - 59:44
The Fred Hutch and UW is one site,
Dr. Bender Igancio
59:44 - 59:51
but there are nine other sites in the country who all contribute to this data set called CENIX,
Dr. Bender Igancio
59:52 - 59:58
which is the Center for AIDS Research data set across,
Dr. Bender Igancio
59:58 - 01:00:01
these 10 big academic HIV clinics.
Dr. Bender Igancio
01:00:01 - 01:00:04
And we all collect the data in a particular way.
Dr. Bender Igancio
01:00:05 - 01:00:07
And it's all sort of,
Dr. Bender Igancio
01:00:07 - 01:00:11
it's all vetted in a way that it works all together across these 10 sites,
Dr. Bender Igancio
01:00:11 - 01:00:14
which are very geographically representative of the United States.
Dr. Bender Igancio
01:00:15 - 01:00:16
But even so,
Dr. Bender Igancio
01:00:16 - 01:00:18
we don't try to answer questions of like,
Dr. Bender Igancio
01:00:18 - 01:00:20
does this cancer therapy work?
Dr. Bender Igancio
01:00:20 - 01:00:22
The type of questions we might answer is,
Dr. Bender Igancio
01:00:24 - 01:00:31
how has the risk of cardiovascular disease changed over the last 10 years in people living with HIV?
Dr. Bender Igancio
01:00:32 - 01:00:34
What is the percentage of people who are getting,
Dr. Bender Igancio
01:00:36 - 01:00:36
you know,
Dr. Bender Igancio
01:00:36 - 01:00:40
hepatitis vaccines and how protective are hepatitis vaccines?
Dr. Bender Igancio
01:00:41 - 01:00:51
We recently worked on a study of MPOCs to see what the vaccine effectiveness was of the Janios vaccine or the MPOCs vaccine in people living with HIV,
Dr. Bender Igancio
01:00:52 - 01:00:55
because there's no clinical trial that can enroll that many people.
Dr. Bender Igancio
01:00:56 - 01:01:00
But when you look across 20,000 people or 25,000 people in the United States living with HIV,
Dr. Bender Igancio
01:01:00 - 01:01:01
some of whom got the vaccine,
Dr. Bender Igancio
01:01:02 - 01:01:03
some of whom didn't,
Dr. Bender Igancio
01:01:03 - 01:01:07
people are all behaving differently as people do across the US.
Dr. Bender Igancio
01:01:07 - 01:01:08
So you don't know what they're doing,
Dr. Bender Igancio
01:01:08 - 01:01:11
but you can look at vaccine effectiveness,
Dr. Bender Igancio
01:01:11 - 01:01:12
which essentially means,
Dr. Bender Igancio
01:01:13 - 01:01:16
of the people who were vaccinated versus not vaccinated,
Dr. Bender Igancio
01:01:16 - 01:01:19
how many people did or didn't get MPOCs and calculate that.
Dr. Bender Igancio
01:01:19 - 01:01:19
So it's just,
Dr. Bender Igancio
01:01:20 - 01:01:20
you know,
Dr. Bender Igancio
01:01:20 - 01:01:22
we did a lot of COVID research that way.
Dr. Bender Igancio
01:01:23 - 01:01:29
We're not trying to answer kind of therapeutic intervention questions that way so much.
Dr. Bender Igancio
01:01:29 - 01:01:33
We're asking questions about population health more that way.
Dr. Bálint Kacsoh
01:01:33 - 01:01:34
- So it's like a very,
Dr. Bálint Kacsoh
01:01:34 - 01:01:39
a broad question that you can kind of get out with just the sheer number of patients that you're looking at.
Dr. Bálint Kacsoh
01:01:40 - 01:01:43
And it's not very nitty gritty answers.
Dr. Bálint Kacsoh
01:01:43 - 01:01:44
just patterns?
Dr. Bender Igancio
01:01:45 - 01:01:47
Some of them are very nitty gritty answers.
Dr. Bender Igancio
01:01:47 - 01:01:47
I think that,
Dr. Bender Igancio
01:01:48 - 01:01:48
you know,
Dr. Bender Igancio
01:01:48 - 01:01:53
we've did it for real card-carrying epidemiologists,
Dr. Bender Igancio
01:01:54 - 01:02:00
there are lots of ways to make sure that the answer is very specific and is very rigorously obtained.
Dr. Bender Igancio
01:02:00 - 01:02:00
It's just,
Dr. Bender Igancio
01:02:01 - 01:02:01
again,
Dr. Bender Igancio
01:02:01 - 01:02:07
it's a completely different answer than one would obtain within a lab or within a clinical trial.
Dr. Bender Igancio
01:02:07 - 01:02:14
Because the truth is that we need all of these things together to understand how systems work.
Dr. Bender Igancio
01:02:15 - 01:02:18
And oftentimes the epidemiology,
Dr. Bender Igancio
01:02:18 - 01:02:31
these sort of big data set research can be either hypothesis generating meaning it's helping us kind of come up with a question that we then take back to the lab and then take back to a clinical trial.
Dr. Bender Igancio
01:02:32 - 01:02:35
Or it can be kind of to confirm something so we can say,
Dr. Bender Igancio
01:02:36 - 01:02:36
you know,
Dr. Bender Igancio
01:02:36 - 01:02:39
maybe this something And we saw this thing in a clinical trial,
Dr. Bender Igancio
01:02:39 - 01:02:40
but the question is,
Dr. Bender Igancio
01:02:40 - 01:02:43
does it really work in people who are behaving as people do?
Dr. Bender Igancio
01:02:44 - 01:02:45
And that's a whole different question from,
Dr. Bender Igancio
01:02:45 - 01:02:52
did it work when we took people who looked exactly this way and fit in exactly these boxes and we watched them very carefully,
Dr. Bender Igancio
01:02:52 - 01:02:52
right?
Dr. Bender Igancio
01:02:53 - 01:02:58
So we need sort of this real world data to look at trends,
Dr. Bender Igancio
01:02:58 - 01:02:59
to come up with questions,
Dr. Bender Igancio
01:02:59 - 01:03:08
to then take that back into clinical trials also and make sure that we're answering the right question for the population and not just,
Dr. Bender Igancio
01:03:08 - 01:03:08
you know,
Dr. Bender Igancio
01:03:08 - 01:03:10
what seems interesting to one of us.
Dr. Bálint Kacsoh
01:03:11 - 01:03:14
- I'm loving learning all the nitty gritty to this because it just shows,
Dr. Bálint Kacsoh
01:03:14 - 01:03:15
right,
Dr. Bálint Kacsoh
01:03:15 - 01:03:20
how much goes into identifying what a target is that you take a next step on.
Dr. Bálint Kacsoh
01:03:21 - 01:03:21
And I like to,
Dr. Bálint Kacsoh
01:03:21 - 01:03:21
you're like,
Dr. Bálint Kacsoh
01:03:22 - 01:03:24
it's this like very interdisciplinary team science.
Dr. Bálint Kacsoh
01:03:24 - 01:03:29
Like you have all the various experts and then you have community members on board as well.
Dr. Bálint Kacsoh
01:03:29 - 01:03:34
Like it's just a very beautifully well done art almost.
Dr. Bálint Kacsoh
01:03:34 - 01:03:36
And we actually just got,
Dr. Bálint Kacsoh
01:03:36 - 01:03:42
I think we can segue now a little bit to the financial side of things before we get back to a little bit more on the community buy-in.
Dr. Bálint Kacsoh
01:03:42 - 01:03:45
We just actually had a donation for $42 coming in,
Dr. Bálint Kacsoh
01:03:46 - 01:03:46
which by the way,
Dr. Bálint Kacsoh
01:03:47 - 01:03:47
thank y'all very much,
Dr. Bálint Kacsoh
01:03:47 - 01:03:51
that we are raising money again for HIV/AIDS research today.
Dr. Bálint Kacsoh
01:03:52 - 01:03:52
Sorry,
Dr. Bálint Kacsoh
01:03:52 - 01:03:55
in collaboration with Fred Hutch Cancer Center,
Dr. Bálint Kacsoh
01:03:56 - 01:04:03
we have incredible guests on with us tonight as we're going through the ins and outs of clinical research,
Dr. Bálint Kacsoh
01:04:03 - 01:04:04
of drug development,
Dr. Bálint Kacsoh
01:04:04 - 01:04:05
of drug discovery,
Dr. Bálint Kacsoh
01:04:05 - 01:04:06
of community buy-in of like,
Dr. Bálint Kacsoh
01:04:07 - 01:04:14
I'm just like kind of jaw dropped on most of the conversation that we're having tonight because I've been having so much fun asking these questions.
Dr. Bálint Kacsoh
01:04:15 - 01:04:17
But can you just give us a perspective on like,
Dr. Bálint Kacsoh
01:04:18 - 01:04:22
why something like a fundraiser were a,
Dr. Bálint Kacsoh
01:04:22 - 01:04:23
you know,
Dr. Bálint Kacsoh
01:04:23 - 01:04:26
a person at home who has $5 to give to something like this,
Dr. Bálint Kacsoh
01:04:26 - 01:04:27
why does it make a difference?
Dr. Bálint Kacsoh
01:04:27 - 01:04:31
Like just a little bit of a perspective on how much something like this can cost.
Dr. Bálint Kacsoh
01:04:32 - 01:04:32
'cause we're talking about like,
Dr. Bálint Kacsoh
01:04:32 - 01:04:33
you know,
Dr. Bálint Kacsoh
01:04:33 - 01:04:34
macaques,
Dr. Bálint Kacsoh
01:04:34 - 01:04:35
dogs,
Dr. Bálint Kacsoh
01:04:35 - 01:04:36
rats,
Dr. Bálint Kacsoh
01:04:36 - 01:04:36
mice,
Dr. Bálint Kacsoh
01:04:37 - 01:04:37
people,
Dr. Bálint Kacsoh
01:04:38 - 01:04:38
getting people in,
Dr. Bálint Kacsoh
01:04:39 - 01:04:39
developing,
Dr. Bálint Kacsoh
01:04:40 - 01:04:40
timing,
Dr. Bálint Kacsoh
01:04:40 - 01:04:41
datasets,
Dr. Bálint Kacsoh
01:04:41 - 01:04:41
analysis,
Dr. Bálint Kacsoh
01:04:42 - 01:04:42
teams,
Dr. Bálint Kacsoh
01:04:42 - 01:04:42
people,
Dr. Bálint Kacsoh
01:04:42 - 01:04:46
like this seems like it could be a huge operation in terms of finance.
Dr. Bálint Kacsoh
01:04:46 - 01:04:48
Is that a fair assessment to it?
Dr. Bender Igancio
01:04:49 - 01:04:50
- Yeah,
Dr. Bender Igancio
01:04:50 - 01:04:50
absolutely.
Dr. Bender Igancio
01:04:51 - 01:04:51
And I think,
Dr. Bender Igancio
01:04:52 - 01:04:53
you know,
Dr. Bender Igancio
01:04:53 - 01:05:04
when we're talking about funding an institution like the Fred Hutch and why I'm so thankful to belong to the Fred Hutch is that there needs to be some degree of infrastructure that's there and operating all the time.
Dr. Bender Igancio
01:05:05 - 01:05:06
Because we can't just,
Dr. Bender Igancio
01:05:06 - 01:05:06
for example,
Dr. Bender Igancio
01:05:07 - 01:05:07
write a grant,
Dr. Bender Igancio
01:05:08 - 01:05:10
get the grant,
Dr. Bender Igancio
01:05:10 - 01:05:11
hire all the people to do the thing,
Dr. Bender Igancio
01:05:12 - 01:05:13
the project's over,
Dr. Bender Igancio
01:05:13 - 01:05:14
we wind back down,
Dr. Bender Igancio
01:05:14 - 01:05:15
we wind back up.
Dr. Bender Igancio
01:05:16 - 01:05:22
We've got tremendous amount of expertise and continuity and the life cycle of a clinical trial is,
Dr. Bender Igancio
01:05:22 - 01:05:33
or of clinical trials is oftentimes two decades between when it leaves non-human primates until it becomes an FDA approved drug.
Dr. Bender Igancio
01:05:34 - 01:05:38
And oftentimes that sort of drug development commercialization piece,
Dr. Bender Igancio
01:05:38 - 01:05:42
the reason why it's done by industry is because it is so expensive.
Dr. Bender Igancio
01:05:43 - 01:05:44
But if we take back,
Dr. Bender Igancio
01:05:44 - 01:05:57
it's gonna kind of go back a step and think about what the Hutch is doing is that it's often funding us to do some pilot work to be able to just do a small number,
Dr. Bender Igancio
01:05:58 - 01:06:03
run a small number of samples or to test something in a small number of people to get a little bit of preliminary information,
Dr. Bender Igancio
01:06:04 - 01:06:06
to keep funding our community advisory boards,
Dr. Bender Igancio
01:06:06 - 01:06:10
some of these things that are around the edges that grants never pay for.
Dr. Bender Igancio
01:06:11 - 01:06:14
And the things that you need to just keep going on a daily basis,
Dr. Bender Igancio
01:06:15 - 01:06:17
you need to have a strong institution behind you.
Dr. Bender Igancio
01:06:18 - 01:06:18
Otherwise,
Speaker 1
01:06:19 - 01:06:19
again,
Dr. Bender Igancio
01:06:19 - 01:06:25
you'd have to sort of spin up and spin down the entire infrastructure for every grant and that would be incredibly inefficient.
Dr. Bálint Kacsoh
01:06:26 - 01:06:28
- And the stop start nature to it,
Dr. Bálint Kacsoh
01:06:28 - 01:06:29
like you were saying as well.
Dr. Bálint Kacsoh
01:06:29 - 01:06:31
Like imagine there's a gap in that kind of funding.
Speaker 1
01:06:32 - 01:06:33
What do you do?
Dr. Bender Igancio
01:06:34 - 01:06:34
- Yeah,
Dr. Bender Igancio
01:06:34 - 01:06:36
and I think that we're looking at a world where,
Dr. Bender Igancio
01:06:37 - 01:06:37
you know,
Dr. Bender Igancio
01:06:37 - 01:06:42
there probably will be a lot of gaps if they haven't already happened this year.
Dr. Bender Igancio
01:06:42 - 01:06:52
My research group has had a huge number of gaps this year because all of our clinical trials were on pause for the majority of this year.
Dr. Bender Igancio
01:06:53 - 01:06:54
You know,
Dr. Bender Igancio
01:06:54 - 01:06:57
we heard testimony in Congress that clinical trials were not impacted.
Dr. Bender Igancio
01:06:57 - 01:07:01
I'm here to tell you that my clinical trials were impacted.
Dr. Bender Igancio
01:07:02 - 01:07:05
We were keeping the people who were on trial safe.
Dr. Bender Igancio
01:07:06 - 01:07:06
We were seeing them,
Dr. Bender Igancio
01:07:07 - 01:07:08
we were collecting their data,
Dr. Bender Igancio
01:07:08 - 01:07:13
but we weren't enrolling any new people or opening any new studies because with the small amount of money we had,
Dr. Bender Igancio
01:07:13 - 01:07:19
we decided that you go back to basics and you take care of the people who are with you right now.
Dr. Bender Igancio
01:07:20 - 01:07:22
And I think that's possibly the future.
Dr. Bender Igancio
01:07:23 - 01:07:23
I mean,
Dr. Bender Igancio
01:07:23 - 01:07:26
that's always the situation of research,
Dr. Bender Igancio
01:07:26 - 01:07:32
But I think the future of research is that it might be more spotty with having dependable funding.
Dr. Bálint Kacsoh
01:07:32 - 01:07:38
Can you comment on the hardships of something like that of like a mid pause on a clinical trial?
Dr. Bálint Kacsoh
01:07:38 - 01:07:40
Because naively,
Dr. Bálint Kacsoh
01:07:40 - 01:07:40
right,
Dr. Bálint Kacsoh
01:07:40 - 01:07:44
I would think that that would have a huge repercussion in terms of potentially moving forward.
Dr. Bálint Kacsoh
01:07:45 - 01:07:50
And it's like you're almost stopping a stone that you've started to get rolling after pushing it up a hill.
Dr. Bálint Kacsoh
01:07:50 - 01:07:52
And now it's like you almost have to push it back up the hill,
Dr. Bálint Kacsoh
01:07:52 - 01:07:53
right to get the momentum back.
Dr. Bender Igancio
01:07:54 - 01:07:54
Yeah,
Dr. Bender Igancio
01:07:54 - 01:07:56
that's exactly correct.
Dr. Bender Igancio
01:07:56 - 01:07:58
That's not a naive way to look at it at all.
Dr. Bender Igancio
01:07:58 - 01:07:59
I think,
Dr. Bender Igancio
01:07:59 - 01:08:00
unfortunately,
Dr. Bender Igancio
01:08:00 - 01:08:07
a lot of the things that we were hearing about stopping things halfway is that there's this idea of,
Dr. Bender Igancio
01:08:07 - 01:08:07
well,
Dr. Bender Igancio
01:08:07 - 01:08:08
then you have half the data.
Dr. Bender Igancio
01:08:09 - 01:08:10
But the truth is,
Dr. Bender Igancio
01:08:10 - 01:08:18
we talked about sample size and we talked about making sure trials are exactly powered ethically to get the right answer,
Dr. Bender Igancio
01:08:19 - 01:08:26
which means that if you were supposed to enroll 470 people in a study and you only had 100 people,
Dr. Bender Igancio
01:08:27 - 01:08:29
that doesn't mean that you saved two thirds of your money.
Dr. Bender Igancio
01:08:29 - 01:08:32
I know that that's not the exact math of that proportion.
Dr. Bender Igancio
01:08:33 - 01:08:35
But that doesn't mean that you saved two thirds of your money.
Dr. Bender Igancio
01:08:36 - 01:08:38
What it means is that you wasted a third of your money.
Dr. Bender Igancio
01:08:40 - 01:08:41
Because it means that,
Dr. Bender Igancio
01:08:41 - 01:08:47
and it also is extremely unethical because it means that all of the contributions of the people who participated in that study,
Dr. Bender Igancio
01:08:47 - 01:08:53
if you were to analyze their data you may not actually get an answer because your sample size is too small to see a difference.
Dr. Bender Igancio
01:08:53 - 01:08:57
And so your conclusion from the study is going to say something like,
Dr. Bender Igancio
01:08:57 - 01:09:00
we did not see a difference between group A and group B,
Dr. Bender Igancio
01:09:01 - 01:09:03
but the study was underpowered to find a difference.
Dr. Bender Igancio
01:09:03 - 01:09:06
And so we therefore conclude that we need to do a bigger study.
Dr. Bender Igancio
01:09:07 - 01:09:10
So what that means is that you're actually redoing all of your work again.
Dr. Bender Igancio
01:09:11 - 01:09:13
And all of these people for whom we have,
Dr. Bender Igancio
01:09:13 - 01:09:13
again,
Dr. Bender Igancio
01:09:13 - 01:09:17
I think informed consent participating in a clinical trial,
Dr. Bender Igancio
01:09:17 - 01:09:19
I treat that as a sacred ethical contract with people.
Dr. Bender Igancio
01:09:21 - 01:09:26
We are contractually ethically obligated to see people through the end of the study.
Dr. Bender Igancio
01:09:26 - 01:09:30
And even if we make sure that each individual person is safely through the trial,
Dr. Bender Igancio
01:09:31 - 01:09:43
we're obligated to finish that trial so that we can then use their data for science to advance other people's care and come up with an answer for all of the time and blood and potentially risk that they,
Dr. Bender Igancio
01:09:43 - 01:09:43
you know,
Dr. Bender Igancio
01:09:43 - 01:09:46
that they they took on to participate.
Dr. Bálint Kacsoh
01:09:48 - 01:09:51
- And the unfortunate thing it sounds like is you might not actually get that,
Dr. Bálint Kacsoh
01:09:52 - 01:09:52
right?
Dr. Bálint Kacsoh
01:09:52 - 01:09:53
You take it through to the end,
Dr. Bálint Kacsoh
01:09:53 - 01:09:57
but it might not be statistically significant because of the precursor.
Dr. Bálint Kacsoh
01:09:57 - 01:10:00
And then my imagining is when you redo the experiment,
Dr. Bálint Kacsoh
01:10:01 - 01:10:04
you don't just lump in their data,
Dr. Bálint Kacsoh
01:10:04 - 01:10:04
right?
Dr. Bálint Kacsoh
01:10:04 - 01:10:06
And then get two thirds of the new people,
Dr. Bálint Kacsoh
01:10:06 - 01:10:10
you have to start with a brand new cohort because of the importance of doing everything,
Dr. Bálint Kacsoh
01:10:10 - 01:10:11
you know,
Dr. Bálint Kacsoh
01:10:11 - 01:10:11
in parallel.
Dr. Bender Igancio
01:10:13 - 01:10:13
- Yeah,
Dr. Bender Igancio
01:10:13 - 01:10:13
I mean,
Dr. Bender Igancio
01:10:13 - 01:10:14
it depends.
Dr. Bender Igancio
01:10:14 - 01:10:16
I think if it's something that was just paused.
Dr. Bender Igancio
01:10:16 - 01:10:16
So for example,
Dr. Bender Igancio
01:10:17 - 01:10:18
for a lot of our studies,
Dr. Bender Igancio
01:10:18 - 01:10:19
this summer enrollment was paused,
Dr. Bender Igancio
01:10:19 - 01:10:24
and which means that we followed people through to the end that we're already on study and we didn't include more people.
Dr. Bender Igancio
01:10:25 - 01:10:26
If you,
Dr. Bender Igancio
01:10:26 - 01:10:28
in relatively short order,
Dr. Bender Igancio
01:10:28 - 01:10:31
reopen the study to enrollment again,
Dr. Bender Igancio
01:10:31 - 01:10:34
then you can lump everybody together.
Dr. Bender Igancio
01:10:34 - 01:10:37
But if you completely wind down a protocol,
Dr. Bender Igancio
01:10:37 - 01:10:39
close it down and analyze it,
Dr. Bender Igancio
01:10:39 - 01:10:42
then it requires restarting a whole new study.
Dr. Bender Igancio
01:10:42 - 01:10:44
and that's not just reopening it.
Dr. Bender Igancio
01:10:45 - 01:10:46
It's probably writing a new protocol.
Dr. Bender Igancio
01:10:47 - 01:10:48
It's getting ethics approval.
Dr. Bender Igancio
01:10:48 - 01:10:49
It's getting FDA approval.
Dr. Bender Igancio
01:10:50 - 01:10:52
It's kind of going all the way back to the drawing board.
Dr. Bender Igancio
01:10:54 - 01:10:58
And so I really think that this idea of like,
Dr. Bender Igancio
01:10:59 - 01:11:00
saving half your money turns into,
Dr. Bender Igancio
01:11:00 - 01:11:02
it's actually wasting half your money.
Dr. Bender Igancio
01:11:02 - 01:11:03
And more than that,
Dr. Bender Igancio
01:11:03 - 01:11:04
because really,
Dr. Bender Igancio
01:11:05 - 01:11:07
before you even start enrolling people in a clinical trial,
Dr. Bender Igancio
01:11:07 - 01:11:11
somebody's probably been at work at that for five years,
Dr. Bender Igancio
01:11:11 - 01:11:12
if not longer.
Dr. Bender Igancio
01:11:12 - 01:11:15
And that somebody is probably a whole team of people.
Dr. Bender Igancio
01:11:16 - 01:11:17
And so,
Dr. Bender Igancio
01:11:17 - 01:11:18
you know,
Dr. Bender Igancio
01:11:18 - 01:11:28
the cost of actually doing the clinical trial of actually enrolling the people is really a small component of that entire kind of stream of work that's been going on for years before that.
Dr. Bálint Kacsoh
01:11:29 - 01:11:30
- And when you're doing that restart,
Dr. Bálint Kacsoh
01:11:31 - 01:11:33
that whole precursor component too,
Dr. Bálint Kacsoh
01:11:34 - 01:11:34
like that four years,
Dr. Bálint Kacsoh
01:11:35 - 01:11:36
also you have to hit the reset button on.
Dr. Bálint Kacsoh
01:11:36 - 01:11:38
So it's not as simple as just like,
Dr. Bálint Kacsoh
01:11:38 - 01:11:39
you know,
Dr. Bálint Kacsoh
01:11:39 - 01:11:41
we open back up the doors and let people back in.
Dr. Bálint Kacsoh
01:11:41 - 01:11:45
It's there's a lot of this backside work that also goes into it.
Dr. Bálint Kacsoh
01:11:45 - 01:11:49
And that's going to make it all the more difficult to like you're like you said,
Dr. Bálint Kacsoh
01:11:49 - 01:11:53
you're like you're charging double or triple the amount that you're originally going for.
Dr. Bálint Kacsoh
01:11:53 - 01:11:54
So these donations,
Dr. Bálint Kacsoh
01:11:54 - 01:11:55
while small,
Dr. Bálint Kacsoh
01:11:55 - 01:11:59
you all can help maintain right the the studies,
Dr. Bálint Kacsoh
01:12:00 - 01:12:01
the clinical trials,
Dr. Bálint Kacsoh
01:12:01 - 01:12:02
the people maintained in them.
Dr. Bálint Kacsoh
01:12:02 - 01:12:05
And hopefully that you can only at worst have that pause,
Dr. Bálint Kacsoh
01:12:05 - 01:12:07
like you were mentioning during the summer.
Dr. Bálint Kacsoh
01:12:07 - 01:12:09
and then instead of like just a whole wind down,
Dr. Bálint Kacsoh
01:12:10 - 01:12:11
which is wild to think about.
Dr. Bálint Kacsoh
01:12:11 - 01:12:11
It would be like,
Dr. Bálint Kacsoh
01:12:11 - 01:12:12
like you said,
Dr. Bálint Kacsoh
01:12:12 - 01:12:14
almost the ethical obligation that you have to the patients.
Dr. Bálint Kacsoh
01:12:15 - 01:12:17
The wind down is unfortunate.
Dr. Bálint Kacsoh
01:12:18 - 01:12:19
Yeah,
Dr. Bálint Kacsoh
01:12:19 - 01:12:28
like what's the best way to help and advocate for something like this for a person at home?
Dr. Bálint Kacsoh
01:12:28 - 01:12:32
Like there's donations and what would be some way that other people could get involved as well?
Dr. Bender Igancio
01:12:34 - 01:12:36
- I think talk to your congressional representatives.
Dr. Bender Igancio
01:12:36 - 01:12:40
I think in past years,
Dr. Bender Igancio
01:12:41 - 01:12:43
science and politics were a lot less intertwined.
Dr. Bender Igancio
01:12:45 - 01:12:47
And I think that regardless of who's representing you in Congress,
Dr. Bender Igancio
01:12:48 - 01:12:54
I think it's really important to just let them know how important science and public health are to you.
Dr. Bender Igancio
01:12:55 - 01:12:58
You can advocate in a way that's completely nonpartisan.
Dr. Bender Igancio
01:12:58 - 01:13:04
You can just talk about how important it is to maintain our public health infrastructure,
Dr. Bender Igancio
01:13:04 - 01:13:05
to maintain the CDC,
Dr. Bender Igancio
01:13:06 - 01:13:08
to maintain funding to the NIH,
Dr. Bender Igancio
01:13:10 - 01:13:16
to maintain funding to research institutes like the Fred Hutch,
Dr. Bender Igancio
01:13:18 - 01:13:20
because it really is,
Dr. Bender Igancio
01:13:20 - 01:13:20
again,
Dr. Bender Igancio
01:13:20 - 01:13:23
all of this infrastructure that we've built helps the whole world,
Dr. Bender Igancio
01:13:24 - 01:13:25
not just the United States.
Dr. Bender Igancio
01:13:27 - 01:13:31
But I think that it's really important that they hear that and that they hear from people,
Dr. Bender Igancio
01:13:31 - 01:13:33
not just people impacted by HIV,
Dr. Bender Igancio
01:13:33 - 01:13:34
but people with autoimmune disease,
Dr. Bender Igancio
01:13:35 - 01:13:35
with cancer,
Dr. Bender Igancio
01:13:37 - 01:13:40
with people with neurologic problems,
Dr. Bender Igancio
01:13:40 - 01:13:41
developmental diseases,
Dr. Bender Igancio
01:13:42 - 01:13:43
with dementia,
Dr. Bender Igancio
01:13:44 - 01:13:48
because science really cuts across all of those conditions.
Dr. Bender Igancio
01:13:49 - 01:13:51
And we can't really say that we're not going,
Dr. Bender Igancio
01:13:52 - 01:13:58
we're just gonna like stop funding one part of science or that we're going to stop paying attention to one part of health,
Dr. Bender Igancio
01:13:58 - 01:13:59
because obviously we,
Dr. Bender Igancio
01:14:00 - 01:14:00
our bodies,
Dr. Bender Igancio
01:14:00 - 01:14:02
our minds are connected as an individual,
Dr. Bender Igancio
01:14:03 - 01:14:06
but as a global community,
Dr. Bender Igancio
01:14:06 - 01:14:07
we're also all connected.
Dr. Bender Igancio
01:14:08 - 01:14:12
And so I think reinstalling that faith in science,
Dr. Bender Igancio
01:14:12 - 01:14:13
the trust in science,
Dr. Bender Igancio
01:14:14 - 01:14:23
making sure that the folks who are making these decisions for us are understanding how important science and public health are to every one of us,
Dr. Bender Igancio
01:14:23 - 01:14:25
regardless of what we believe,
Dr. Bender Igancio
01:14:26 - 01:14:28
what kind of medical conditions we have,
Dr. Bender Igancio
01:14:28 - 01:14:29
we all need science.
Dr. Bálint Kacsoh
01:14:31 - 01:14:31
- Yeah,
Dr. Bálint Kacsoh
01:14:31 - 01:14:31
I love that.
Dr. Bálint Kacsoh
01:14:32 - 01:14:32
I love that.
Dr. Bálint Kacsoh
01:14:33 - 01:14:33
What,
Dr. Bálint Kacsoh
01:14:33 - 01:14:37
so one thing that you had mentioned was the importance of public buy-in to this,
Dr. Bálint Kacsoh
01:14:37 - 01:14:37
right?
Dr. Bálint Kacsoh
01:14:37 - 01:14:38
Of like,
Dr. Bálint Kacsoh
01:14:38 - 01:14:41
regardless of what you're doing in terms of any kind of clinical trial,
Dr. Bálint Kacsoh
01:14:41 - 01:14:43
whether it be on HIV/AIDS,
Dr. Bálint Kacsoh
01:14:43 - 01:14:43
cancer,
Dr. Bálint Kacsoh
01:14:44 - 01:14:44
anything else,
Dr. Bálint Kacsoh
01:14:45 - 01:14:47
if you don't have public buy-in,
Dr. Bálint Kacsoh
01:14:47 - 01:14:48
it's not gonna work.
Dr. Bálint Kacsoh
01:14:49 - 01:14:51
Can you touch a little bit about how,
Dr. Bálint Kacsoh
01:14:52 - 01:14:52
you know,
Dr. Bálint Kacsoh
01:14:52 - 01:14:54
we mentioned that there's on the advisory boards,
Dr. Bálint Kacsoh
01:14:55 - 01:14:59
there's your everyday persons on those as well and being pulled in.
Dr. Bálint Kacsoh
01:15:00 - 01:15:09
What are some other components that you feel work and are helpful in terms of bringing more people on and just getting that public buy-in?
Dr. Bender Igancio
01:15:11 - 01:15:12
- I think just education,
Dr. Bender Igancio
01:15:12 - 01:15:14
people knowing and speaking about it.
Dr. Bender Igancio
01:15:15 - 01:15:19
I think if anybody comes away having learned one thing today,
Dr. Bender Igancio
01:15:21 - 01:15:25
let that be that undetectable is untransmissible,
Dr. Bender Igancio
01:15:25 - 01:15:29
meaning people whose HIV is treated cannot pass it on,
Dr. Bender Igancio
01:15:29 - 01:15:30
have zero risk of passing it on,
Dr. Bender Igancio
01:15:31 - 01:15:32
drop it into conversation with somebody.
Dr. Bender Igancio
01:15:32 - 01:15:32
I mean,
Dr. Bender Igancio
01:15:33 - 01:15:34
that may sound really weird.
Dr. Bender Igancio
01:15:34 - 01:15:35
I do it all the time.
Dr. Bender Igancio
01:15:35 - 01:15:35
Then again,
Dr. Bender Igancio
01:15:35 - 01:15:40
I had to ask my kid in the car today if they found my condom earring under the car seat.
Dr. Bender Igancio
01:15:42 - 01:15:42
So,
Speaker 1
01:15:43 - 01:15:44
you know,
Dr. Bender Igancio
01:15:44 - 01:15:45
they did.
Dr. Bender Igancio
01:15:46 - 01:15:46
And then I said,
Dr. Bender Igancio
01:15:46 - 01:15:46
I'm sorry,
Dr. Bender Igancio
01:15:46 - 01:15:49
that's kind of a weird question coming from mom and my dad,
Dr. Bender Igancio
01:15:49 - 01:15:49
well,
Dr. Bender Igancio
01:15:49 - 01:15:50
not from you.
Dr. Bender Igancio
01:15:50 - 01:15:52
That's a totally normal question coming from you.
Dr. Bender Igancio
01:15:54 - 01:15:54
But yeah,
Dr. Bender Igancio
01:15:54 - 01:15:55
I mean,
Dr. Bender Igancio
01:15:55 - 01:15:56
just drop it into conversation.
Dr. Bender Igancio
01:15:56 - 01:15:57
Just,
Dr. Bender Igancio
01:15:57 - 01:15:57
you know,
Dr. Bender Igancio
01:15:57 - 01:16:01
if people are saying things that don't make sense or you're having a random conversation,
Dr. Bender Igancio
01:16:02 - 01:16:02
just ask people,
Dr. Bender Igancio
01:16:03 - 01:16:03
hey,
Dr. Bender Igancio
01:16:03 - 01:16:09
did you know that people who take HIV treatment can't pass it on to anybody else?
Dr. Bender Igancio
01:16:09 - 01:16:10
That there's zero risk of acquiring HIV?
Dr. Bender Igancio
01:16:11 - 01:16:11
Hey,
Dr. Bender Igancio
01:16:11 - 01:16:13
did you know that with two shots a year,
Dr. Bender Igancio
01:16:14 - 01:16:16
there is zero risk of acquiring HIV,
Dr. Bender Igancio
01:16:17 - 01:16:21
but that medication costs as much as a mid-sized sedan?
Dr. Bender Igancio
01:16:22 - 01:16:24
And so we need to work on ways to,
Dr. Bender Igancio
01:16:24 - 01:16:24
you know,
Dr. Bender Igancio
01:16:24 - 01:16:27
make that more affordable for people globally to get,
Dr. Bender Igancio
01:16:27 - 01:16:29
just get the education out there,
Dr. Bender Igancio
01:16:29 - 01:16:30
which is what you're doing.
Dr. Bender Igancio
01:16:31 - 01:16:32
And I so appreciate you for that.
Dr. Bálint Kacsoh
01:16:33 - 01:16:35
- And it's like furthering the de-stigmatization,
Dr. Bálint Kacsoh
01:16:35 - 01:16:35
right?
Dr. Bálint Kacsoh
01:16:35 - 01:16:36
'Cause you mentioned too,
Dr. Bálint Kacsoh
01:16:36 - 01:16:40
there is like the associated stigma of even getting that daily pill,
Dr. Bálint Kacsoh
01:16:41 - 01:16:41
right?
Dr. Bálint Kacsoh
01:16:41 - 01:16:43
And even if it's not out in the world in front of everyone,
Dr. Bálint Kacsoh
01:16:43 - 01:16:46
just like your own mental perception of it,
Dr. Bálint Kacsoh
01:16:46 - 01:16:46
right?
Dr. Bálint Kacsoh
01:16:46 - 01:16:52
And so it's really cool that you're not just a doctor of health,
Dr. Bálint Kacsoh
01:16:53 - 01:16:53
right?
Dr. Bálint Kacsoh
01:16:53 - 01:16:57
you're almost a doctor of the spirit too that you have to take into account for these kinds of things.
Dr. Bálint Kacsoh
01:16:57 - 01:16:57
And I just,
Dr. Bálint Kacsoh
01:16:58 - 01:16:58
you know,
Dr. Bálint Kacsoh
01:16:58 - 01:17:02
I think that makes the work that you're doing all the more incredible because it is so important.
Dr. Bálint Kacsoh
01:17:02 - 01:17:04
And I love to see that it's important to you,
Dr. Bálint Kacsoh
01:17:04 - 01:17:06
the scientist who's helping the people,
Dr. Bálint Kacsoh
01:17:07 - 01:17:07
right?
Dr. Bálint Kacsoh
01:17:08 - 01:17:09
Beyond just here's a drug,
Dr. Bálint Kacsoh
01:17:09 - 01:17:09
take this,
Dr. Bálint Kacsoh
01:17:10 - 01:17:10
right?
Dr. Bálint Kacsoh
01:17:11 - 01:17:12
And it kind of goes that like really,
Dr. Bálint Kacsoh
01:17:12 - 01:17:18
that really amazing like bedside manner that we have to like ensure that it's helping people to the max.
Speaker 1
01:17:19 - 01:17:19
- Absolutely.
Speaker 1
01:17:19 - 01:17:19
I mean,
Dr. Bender Igancio
01:17:19 - 01:17:23
I have to say as someone who takes care of lots of folks with HIV,
Dr. Bender Igancio
01:17:23 - 01:17:24
sometimes when folks come in to see me,
Dr. Bender Igancio
01:17:24 - 01:17:26
we don't even talk about HIV.
Dr. Bender Igancio
01:17:27 - 01:17:29
Depending on if I even need to,
Dr. Bender Igancio
01:17:29 - 01:17:34
I may or may not ask them how well they're taking their medication because it may be obvious that they're doing great.
Dr. Bender Igancio
01:17:34 - 01:17:36
And we talk about every other thing under the sun,
Dr. Bender Igancio
01:17:36 - 01:17:37
mental health,
Dr. Bender Igancio
01:17:37 - 01:17:38
substance use,
Dr. Bender Igancio
01:17:38 - 01:17:38
aging,
Dr. Bender Igancio
01:17:39 - 01:17:40
you know,
Dr. Bender Igancio
01:17:40 - 01:17:42
all the stress that folks have in their life.
Dr. Bender Igancio
01:17:42 - 01:17:44
Like that's what keeps me going is,
Dr. Bender Igancio
01:17:44 - 01:17:45
you know,
Dr. Bender Igancio
01:17:45 - 01:17:46
getting to share that with people,
Dr. Bender Igancio
01:17:47 - 01:17:48
sharing stories,
Dr. Bender Igancio
01:17:48 - 01:17:49
being able to witness lives.
Dr. Bender Igancio
01:17:50 - 01:17:51
Because the truth is,
Dr. Bender Igancio
01:17:51 - 01:17:54
is that on a one-to-one personal level,
Dr. Bender Igancio
01:17:54 - 01:17:56
folks who are accessing medical care,
Dr. Bender Igancio
01:17:56 - 01:17:59
HIV treatment is so easy.
Dr. Bender Igancio
01:18:00 - 01:18:06
It's fixing the rest of the system that's preventing everybody from being able to participate in that,
Dr. Bender Igancio
01:18:07 - 01:18:14
being able to get their head around this condition that we've built so much stigma into as a society,
Dr. Bender Igancio
01:18:15 - 01:18:16
really for no reason.
Dr. Bálint Kacsoh
01:18:17 - 01:18:17
- Yeah,
Dr. Bálint Kacsoh
01:18:17 - 01:18:18
well said.
Dr. Bálint Kacsoh
01:18:18 - 01:18:23
What is something that you are most excited about that's upcoming in your research?
Dr. Bálint Kacsoh
01:18:24 - 01:18:24
Like,
Dr. Bálint Kacsoh
01:18:24 - 01:18:27
is there an experiment or an upcoming drug?
Dr. Bálint Kacsoh
01:18:27 - 01:18:30
I know you can't necessarily tell us about like the fine details of it,
Dr. Bálint Kacsoh
01:18:30 - 01:18:31
but just something where you're like,
Dr. Bálint Kacsoh
01:18:32 - 01:18:33
oh man,
Dr. Bálint Kacsoh
01:18:33 - 01:18:34
I'm like really excited for this.
Dr. Bálint Kacsoh
01:18:34 - 01:18:35
This is gonna be so cool.
Dr. Bálint Kacsoh
01:18:35 - 01:18:37
Or if that has the potential to be so cool,
Dr. Bálint Kacsoh
01:18:38 - 01:18:38
right?
Dr. Bálint Kacsoh
01:18:38 - 01:18:40
Like any of that,
Dr. Bálint Kacsoh
01:18:40 - 01:18:44
whether it be on the HIV side of things or a side drug,
Dr. Bálint Kacsoh
01:18:44 - 01:18:45
what are you most excited about?
Dr. Bender Igancio
01:18:48 - 01:18:52
I think it's a couple of the upcoming studies that we have for long acting treatment for HIV.
Dr. Bender Igancio
01:18:53 - 01:19:05
So we have a study coming up that will open just in the United States that's using two different long acting HIV medications that will be given one every two months,
Dr. Bender Igancio
01:19:05 - 01:19:06
one every six months.
Dr. Bender Igancio
01:19:07 - 01:19:19
And another study that's going to be using that same drug combination and people will be randomized to take that long-acting combination versus continuing a medication called TLD,
Dr. Bender Igancio
01:19:19 - 01:19:21
which is a triple therapy drug,
Dr. Bender Igancio
01:19:21 - 01:19:24
the generic drug that's available in most countries around the world.
Dr. Bender Igancio
01:19:25 - 01:19:33
And both of those studies are for people that are for whom HIV treatment is failing because they can't take a daily pill.
Dr. Bender Igancio
01:19:34 - 01:19:37
Notice I said they're not feeling treatment,
Dr. Bender Igancio
01:19:37 - 01:19:38
the treatment is feeling them.
Dr. Bender Igancio
01:19:39 - 01:19:43
So I'm really excited about these studies because oftentimes when we do research,
Dr. Bender Igancio
01:19:43 - 01:19:48
we try to find the exact perfect person for research.
Dr. Bender Igancio
01:19:48 - 01:19:50
And these two studies are really saying,
Dr. Bender Igancio
01:19:50 - 01:19:51
"Okay,
Dr. Bender Igancio
01:19:51 - 01:19:54
who are the people who are not being served by current HIV treatment?
Dr. Bender Igancio
01:19:54 - 01:20:11
And can we take these medications that we already know work well in people who take their medication easily and see if these treatments work for them and figure out whether this dosing schedule and this way of giving it can really make an impact for people who are struggling to take their medication every day.
Dr. Bálint Kacsoh
01:20:13 - 01:20:14
I I love how you phrased it.
Dr. Bálint Kacsoh
01:20:14 - 01:20:16
I love the excitement for it too.
Dr. Bálint Kacsoh
01:20:16 - 01:20:20
It's just it's gonna be one of those big game changers I feel.
Dr. Bálint Kacsoh
01:20:20 - 01:20:23
And just making it all the easier for again,
Dr. Bálint Kacsoh
01:20:23 - 01:20:23
like you said,
Dr. Bálint Kacsoh
01:20:23 - 01:20:24
the accessibility,
Dr. Bálint Kacsoh
01:20:25 - 01:20:25
right,
Dr. Bálint Kacsoh
01:20:25 - 01:20:26
then the treatment,
Dr. Bálint Kacsoh
01:20:26 - 01:20:31
the long term treatment as well and the injections and possibly whatever else that's going to affect,
Dr. Bálint Kacsoh
01:20:32 - 01:20:32
right,
Dr. Bálint Kacsoh
01:20:32 - 01:20:36
any other kinds of infectious treatments on that same long term run.
Dr. Bálint Kacsoh
01:20:38 - 01:20:39
As we wind down,
Dr. Bálint Kacsoh
01:20:39 - 01:20:43
one question that we've asked all of our female scientists is,
Dr. Bálint Kacsoh
01:20:44 - 01:20:44
you know,
Dr. Bálint Kacsoh
01:20:45 - 01:20:49
we've we've kind of touched on this throughout is that you're a badass woman in STEM,
Dr. Bálint Kacsoh
01:20:49 - 01:20:49
right,
Dr. Bálint Kacsoh
01:20:50 - 01:20:51
is that you've got the kiddos,
Dr. Bálint Kacsoh
01:20:52 - 01:20:53
you got the family,
Dr. Bálint Kacsoh
01:20:53 - 01:20:57
you've got an incredible research program.
Dr. Bálint Kacsoh
01:20:57 - 01:20:57
Like,
Dr. Bálint Kacsoh
01:20:57 - 01:21:01
I hope everyone's jaw has been hitting the floor on everything that you've been talking about tonight,
Dr. Bálint Kacsoh
01:21:01 - 01:21:02
because it is that impressive.
Dr. Bálint Kacsoh
01:21:03 - 01:21:05
But can you just highlight a little bit for people?
Dr. Bálint Kacsoh
01:21:05 - 01:21:08
What has it been like for you as a woman in STEM?
Dr. Bálint Kacsoh
01:21:08 - 01:21:12
And what advice would you give to any up and coming women who are watching,
Dr. Bálint Kacsoh
01:21:12 - 01:21:13
listening,
Dr. Bálint Kacsoh
01:21:14 - 01:21:15
maybe interested in science?
Dr. Bálint Kacsoh
01:21:15 - 01:21:18
How would they be able to really get into the sciences?
Dr. Bálint Kacsoh
01:21:18 - 01:21:20
And just knowing what you do now,
Dr. Bálint Kacsoh
01:21:20 - 01:21:21
what would you tell them?
Dr. Bender Igancio
01:21:21 - 01:21:22
Gosh,
Dr. Bender Igancio
01:21:22 - 01:21:22
I mean,
Dr. Bender Igancio
01:21:22 - 01:21:27
I think it's always more difficult to be a woman in STEM than a man.
Dr. Bender Igancio
01:21:27 - 01:21:33
I think something that I think about a lot as a white woman in STEM,
Dr. Bender Igancio
01:21:33 - 01:21:34
so I'll just flip the question even more.
Dr. Bender Igancio
01:21:34 - 01:21:41
Is that a white woman in STEM that I don't think that I face as many challenges as a lot of other underrepresented groups in STEM,
Dr. Bender Igancio
01:21:42 - 01:21:43
specifically in infectious disease.
Dr. Bender Igancio
01:21:43 - 01:21:45
There are a large number of women.
Dr. Bender Igancio
01:21:46 - 01:21:48
My division heads a woman in both my institutions.
Dr. Bender Igancio
01:21:49 - 01:21:50
I have a lot of great female mentors,
Dr. Bender Igancio
01:21:50 - 01:21:53
a lot of great female leaders,
Dr. Bender Igancio
01:21:54 - 01:21:57
but there are a lot of people who are not well represented,
Dr. Bender Igancio
01:21:58 - 01:22:00
black and brown physician scientists,
Dr. Bender Igancio
01:22:01 - 01:22:07
people belonging to other underrepresented communities and folks who didn't come into science with sort of intergenerational wealth.
Dr. Bender Igancio
01:22:08 - 01:22:13
And I think that's really probably the most challenging thing is to get people who are not,
Dr. Bender Igancio
01:22:14 - 01:22:17
who don't see themselves in science into science.
Dr. Bender Igancio
01:22:18 - 01:22:31
And you've talked about the fact that I think financially it's very challenging to be a scientist and there's a kind of a big area of training in which people don't make a lot of money and work very hard.
Dr. Bender Igancio
01:22:31 - 01:22:34
And for folks who don't have a partner who can support their family,
Dr. Bender Igancio
01:22:35 - 01:22:37
or who come in with a lot of debt,
Dr. Bender Igancio
01:22:37 - 01:22:40
or maybe they're the first person in their family in college,
Dr. Bender Igancio
01:22:41 - 01:22:41
first-gen students,
Dr. Bender Igancio
01:22:42 - 01:22:43
that chasm can be really,
Dr. Bender Igancio
01:22:43 - 01:22:44
really difficult to cross.
Dr. Bender Igancio
01:22:45 - 01:22:47
And so I think I'm trying to call in-- I mean,
Dr. Bender Igancio
01:22:47 - 01:22:47
specifically,
Dr. Bender Igancio
01:22:47 - 01:22:58
I'm trying to call in my other people who are already established in the field to make sure that everybody is welcome in STEM.
Speaker 1
01:23:00 - 01:23:01
I love it.
Speaker 1
01:23:01 - 01:23:02
I love it.
Speaker 1
01:23:02 - 01:23:02
Well,
Dr. Bálint Kacsoh
01:23:03 - 01:23:06
thank you very much for your time tonight,
Dr. Bálint Kacsoh
01:23:06 - 01:23:09
for sharing your expertise with us and all of your amazing insights.
Dr. Bálint Kacsoh
01:23:10 - 01:23:13
I hope folks have enjoyed our discussion.
Dr. Bálint Kacsoh
01:23:13 - 01:23:14
I know again,
Dr. Bálint Kacsoh
01:23:14 - 01:23:19
like you're listening later on or you're watching my jaw was probably dropping for most of it.
Dr. Bálint Kacsoh
01:23:19 - 01:23:21
It was just again,
Dr. Bálint Kacsoh
01:23:21 - 01:23:23
so much fun and thank you for your time and you know,
Dr. Bálint Kacsoh
01:23:24 - 01:23:24
again,
Dr. Bálint Kacsoh
01:23:24 - 01:23:25
sharing your knowledge with us.
Dr. Bálint Kacsoh
01:23:25 - 01:23:27
We appreciate you and guys again,
Dr. Bálint Kacsoh
01:23:27 - 01:23:33
you can support this incredible work by hitting that dono link in the chat right now and supporting Dr.
Dr. Bálint Kacsoh
01:23:33 - 01:23:34
Bender Ignacio's work.
Speaker 1
01:23:35 - 01:23:35
- Thank you.
Dr. Bender Igancio
01:23:36 - 01:23:38
- Thank you again for-- - Thank you so much for hosting me.
Dr. Bender Igancio
01:23:38 - 01:23:48
I've had a great time speaking with you and it's really generous of you to let us use your platform to share more wonderful science and to talk about the work that we do.
Dr. Bender Igancio
01:23:48 - 01:23:51
So I really appreciate you having me on.
Dr. Bálint Kacsoh
01:23:52 - 01:23:52
- Likewise,
Dr. Bálint Kacsoh
01:23:52 - 01:23:53
thank you so much.
Dr. Bálint Kacsoh
01:23:53 - 01:23:55
And we hope to get you back soon.
Dr. Bálint Kacsoh
01:23:55 - 01:23:58
If you ever want to come on and talk about any of your science,
Dr. Bálint Kacsoh
01:23:58 - 01:23:59
we'd love to have you back.
Speaker 1
01:24:00 - 01:24:00
Absolutely.
Dr. Bender Igancio
01:24:00 - 01:24:01
Absolutely.
Dr. Bender Igancio
01:24:01 - 01:24:01
Great.
Dr. Bálint Kacsoh
01:24:02 - 01:24:02
Thank you again.
Dr. Bálint Kacsoh
01:24:03 - 01:24:03
Have a good night.
Dr. Bálint Kacsoh
01:24:03 - 01:24:03
Have a good night.
Speaker 1
01:24:04 - 01:24:06
[MUSIC PLAYING] --science is for everyone.
Speaker 1
01:24:06 - 01:24:06
All backgrounds,
Speaker 1
01:24:06 - 01:24:07
all ages,
Speaker 1
01:24:07 - 01:24:07
all genders,
Speaker 1
01:24:08 - 01:24:09
and all walks of life deserve an education.
Speaker 1
01:24:10 - 01:24:11
Come be one of us.