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Published by: barzana on Apr 23, 2011
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IntensIve care specIal 
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com oou uouym - p 33 auob sO
 o - p 34rui  i of cIn - p 31
the MagazIne FOr healthcare decIsIOn Makers
 Week news updates onwww.ihe-onine.com
 Volume 35 Iue 5IHE Ocober 2009
www.ihe-online.com & search 45218
It is now over a quar-ter o a century sinceDr Luc Montagnierrst identied the virus that causesAIDS, which at thattime was a diseasewith low prevalence. Since then HIV/AIDS has spread around the globe;according to the most recent report jointly released by WHO, UNAIDS andUNICEF last year, the number o peopleliving with HIV has risen to 33.2 mil-lion, 22.5 million o whom reside in sub-Saharan Arica. wo and a hal millionpeople were newly inected with HIV in2007. Faced with such daunting acts, isthere any cause or optimism?A major achievement in the ght againstAIDS is that over three million peoplein the most severely aected resource-poor countries are now receiving anti-retroviral therapy (AR). Tis is theresult o the increased availability o cheaper drugs or lower income coun-tries, simpler, standardised drug regi-mens and the growth o decentralisedclinics and laboratories, enabling morepeople to be appropriately tested, diag-nosed and treated. Providing acilitiesin remote areas has especially benetedwomen and children; AR has success-ully prevented vertical transmissionand combination AR taken rom latepregnancy until six months aer birthdramatically reduces breasteedingmother-to-child transmission.In spite o such substantial progress,however, there has been a very realobstacle to achieving the UNAIDS’ goalo ‘universal access to HIV prevention.....by 2010’, namely a sae and eective vac-cine. wenty-ve years ago, aer theHIV virus had been isolated, MargaretHeckler, then US Secretary o Health,Education and Welare, blithely declaredthat an eective HIV vaccine wouldbe available within two years. Despiteconcerted eorts as well as sporadicannouncements o success, this goal stillremains elusive a quarter o a century later. Why have previous vaccines ailed,and will the ALVAC/AIDSVAX combi-nation, which is currently being laudedby the mass media on the basis o as yetunpublished data rom Phase III trials,really help achieve the UNAIDS’ goal?Most initial eorts towards engineeringa vaccine were directed towards the viralenvelope glycoprotein, gp120, which itwas thought would elicit an antibody response that would prevent inection.Unortunately the heavily glycosylated viral envelope protein both maskspotential protein epitopes, and preventsantibodies binding eectively even i they are generated. In addition the viralenvelope proteins vary more than other viruses, both geographically and overtime; the HIV virus is highly mutable.Phase II trials with a previous vaccine,(V520) based on an attenuated adenovi-rus carrying three HIV Subtype B genes,which involved over three thousandpaticipants spread over three continents,were abandoned prematurely becausethe vaccine proved ineective.Now the Phase III trial with a combi-nation o two earlier vaccines, namely ALVAC, which employs a canary-pox virus to carry three HIV genes,and AIDSVAC, based on gp120, hasreported a reduced risk o contractingHIV o 31.2% in Tai volunteers. Fulldata will be presented at the AIDS Vac-cine 2009 conerence which starts onOctober 19th. In the meantime we andthe mass media should realise that thisdevelopment may be just a small step ormankind, not the giant leap or which weall hope.
 An eecive HIV vaccine a la?
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www.ihe-online.com & search 45187
EdItOr’s LEttEr
– Issue N°5 – Oct. 2009

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