After qualifying as a vet, Koen Van Rompay knew that working in practice would not be for him. He was accepted for postgraduate studies at the University of California, Davis, and became involved in HIV/AIDS research. As discussed in a ‘Ten-minute chat’ on p ii, he also set up a charity, Sahaya International, which supports grass roots educational and other programmes in Asia and Africa
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I WAS born in 1965, and grew up in the suburbs of Antwerp (Belgium) in a middle-class family of four children. My passion for animals started early. I remember in kindergarten being fascinated by an aquarium that one of the teachers had installed in the classroom. I was lucky that my parents allowed me to explore this passion. Over the years, our house and garden became a small zoo, where I spent most of my free time studying and breeding a variety of birds and fish.
In high school I majored in mathematics and, as this was my strongest subject (rather than biology), I toyed with the idea of becoming a mathematician. In the end, I decided to listen to my heart and pursue my childhood dream, and I started veterinary college. After completing the first three years at the University of Antwerp, I continued for the final three years at the University of Ghent.
Koen Van Rompay with two of the many children supported by Sahaya International
By the fifth year of my veterinary studies, I was fully aware that entering veterinary practice wouldn't be ideal for me. I was too much of an introvert, and had a speech disability. At the same time, research appealed to me. Not having travelled much, I also felt the urge to explore the world beyond Belgium, to learn what was out there, to learn more about myself and find my niche in the world. However, I had no idea how to go about it, where I should go, and if I should even try it, considering my lack of experience and funds. At a Michael Jackson concert in Belgium in August 1988, during the song ‘Man in the Mirror’, I knew that the USA was the place where, with hard work, one could make dreams come true. I successfully applied for a one-year fellowship of the Belgian American Educational Foundation and was also accepted for graduate studies at the University of California, Davis. In September 1989, I left Belgium with two suitcases and took my first flight towards a large unknown, the USA.
My first interest was research on wildlife and zoo animals, and I was fortunate to get one of the world's leading veterinarians in that arena, Murray Fowler, as my major professor. However, it dawned on me that due to the relative lack of funds in this field, my one-year fellowship would soon end. On the advice of my graduate adviser, I joined Niels Pedersen, the veterinarian who had discovered feline immunodeficiency virus. I became involved with HIV/AIDS research at the California National Primate Research Center. After obtaining my PhD there in 1994, I decided to stay to continue my research.
In those days, simian immunodeficiency virus infection of macaques was still in the early stages of becoming the prime animal model of HIV infection of people. Doing research on animals was a steep learning curve for me, and was initially associated with ethical concerns that I had to resolve. Besides learning a lot of laboratory assays, I realised the importance of careful biomedical research, not only to improve human health, but also to improve animal health. I also witnessed the excellent veterinary care and husbandry that is provided to the animals at our facility.
In 1990, I was given my own research project. I was asked to be in charge of a relatively small experiment to try to determine the efficacy of AZT (which at that time was the only drug approved for HIV-infected people), in infant macaques. The main goal was to validate the macaque model in the pipeline of anti-HIV drug development, as attempts by other investigators to demonstrate the efficacy of AZT in macaques had so far failed. We demonstrated that if AZT was given to infant macaques shortly before exposure to the virus, it could block infection. At that time, this was the first demonstration that an anti-HIV drug could prevent infection, and this created high enthusiasm. Our data helped guide the clinical trials which in 1994 demonstrated that providing AZT to HIV-infected pregnant women and their infants reduced the likelihood of HIV transmission by two thirds. This was a major breakthrough.
This first success sparked our interest to further develop this animal model to test novel HIV drugs. This was timely as AZT by itself was relatively weak and toxic for people who were already HIV-infected, and the benefits were transient as the virus became drug-resistant. In 1995, Dr Pedersen introduced me to Norbert Bischofberger of Gilead Sciences, which at that time was a small start-up biotech company in California. It had obtained the licence for the clinical development of a novel category of HIV drugs that were active in vitro, but it lacked the preclinical data in animal models that were needed to move forward into human trials. We decided to test one of the compounds, tenofovir, in macaques that were already SIV-infected. We were surprised by the results as its efficacy was unprecedented.
Since then, I have spent much of my research efforts studying the different aspects of the drug, like drug resistance, prophylaxis, and long-term efficacy and safety, including during pregnancy. It is satisfying that our observations in macaques were predictive of the results obtained in human clinical trials.
Tenofovir was approved by regulatory agencies in the USA and Europe about 13 years ago, and has become the most widely used HIV drug in the world, as part of combination regimens that are now treating millions of HIV-infected people, and recently also as a pre-exposure prophylaxis regimen to protect uninfected people who engage in high-risk behaviour.
While our research is only one link in the long chain of the clinical development of a medical product, it has been a humbling experience for everyone in our team to be part of. We hope our journey helps people understand the impact that veterinarians can have on global health, and inspires young people to consider biomedical research as a career option.
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