It is now over a quar-ter o a century sinceDr Luc Montagnierrst identied 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 Arica. wo and a hal millionpeople were newly inected 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 aected 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 benetedwomen and children; AR has success-ully prevented vertical transmissionand combination AR taken rom latepregnancy until six months aer birthdramatically reduces breasteedingmother-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 sae and eective vac-cine. wenty-ve years ago, aer theHIV virus had been isolated, MargaretHeckler, then US Secretary o Health,Education and Welare, blithely declaredthat an eective HIV vaccine wouldbe available within two years. Despiteconcerted eorts 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 eorts towards engineeringa vaccine were directed towards the viralenvelope glycoprotein, gp120, which itwas thought would elicit an antibody response that would prevent inection.Unortunately the heavily glycosylated viral envelope protein both maskspotential protein epitopes, and preventsantibodies binding eectively 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 ineective.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 conerence 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 eecive HIV vaccine a la?
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– Issue N°5 – Oct. 2009