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HIV vaccine development

An HIV vaccine could be either a preventive vaccine or a therapeutic


vaccine, which means it will either protect individuals from being
infected with HIV or treat HIV-infected individuals. And it could
either induce an immune response against HIV (active vaccination
approach) or consist of preformed antibodies against HIV (passive
vaccination approach).[1]

There is currently no licensed HIV vaccine on the market, but


multiple research projects are trying to find an effective vaccine.
Evidence observed from humans shows that a vaccine may be
possible: Some, but certainly not all, HIV-infected individuals
naturally produce broadly neutralizing antibodies which keep the Various approaches for HIV vaccine
virus suppressed, and these people remain asymptomatic for decades. development
Potential broadly neutralizing antibodies have been cloned in the
laboratory (monoclonal antibodies) and are being tested in passive
vaccination clinical trials.

Many trials have shown no efficacy, but one HIV vaccine regimen, RV 144, has been shown to prevent HIV
in some individuals in Thailand.

The urgency of the search for a vaccine against HIV stems from the AIDS-related death toll of over 35 million
people since 1981.[2] In 2002, AIDS became the primary cause of death due to an infectious agent in
Africa.[3]

Alternative medical treatments to a vaccine exist. For the treatment of HIV-infected individuals, highly active
antiretroviral therapy (HAART) medication has been demonstrated to provide many benefits to HIV-infected
individuals, including improved health, increased lifespan, control of viremia, and prevention of transmission
to babies and partners. HAART must be taken lifelong without interruption to be effective, and cannot cure
HIV. Options for the prevention of HIV infection in HIV-uninfected individuals include safer sex (for example
condom use), antiretroviral strategies (pre-exposure prophylaxis[4] and post-exposure prophylaxis) and medical
male circumcision.[5] Vaccination has proved a powerful public health tool in vanquishing other diseases, and
an HIV vaccine is generally considered as the most likely, and perhaps the only way by which the HIV
pandemic can be halted. However, HIV remains a challenging target for a vaccine.

Contents
Difficulties in development
HIV structure
Animal model
Clinical trials
Phase I
Phase II
Phase III
Economics
Classification of possible vaccines
Filtering virions from blood (Stage I)
Approaches to catching the virion (Stage I-III, VI, VII)
Approaches to destroying or damaging the virion or its parts (Stage I-VII)
Blocking replication (Stage V)
Biological, chemical or physical approaches to inhibit the process of phases
Inhibiting the functionality of infected cells (Stage VI-VII)
Future work
See also
References
External links

Difficulties in development
In 1984, after the confirmation of the etiological agent of AIDS by scientists at the U.S. National Institutes of
Health and the Pasteur Institute, the United States Health and Human Services Secretary Margaret Heckler
declared that a vaccine would be available within two years.[6] However, the classical vaccination approach
that is successful in the control of other viral diseases - priming the adaptive immunity to recognize the viral
envelope proteins - did not work against HIV. Many factors make the development of an HIV vaccine
different from other classic vaccines:[7]

Classic vaccines mimic natural immunity against reinfection as seen in individuals recovered
from infection; there are almost no recovered AIDS patients.
Most vaccines protect against disease, not against infection; HIV infection may remain latent for
long periods before causing AIDS.
Most effective vaccines are whole-killed or live-attenuated organisms; killed HIV-1 does not
retain antigenicity and the use of a live retrovirus vaccine raises safety issues.

HIV structure

The epitopes of the viral envelope are more variable than those of
many other viruses. Furthermore, the functionally important epitopes
of the gp120 protein are masked by glycosylation, trimerisation and
receptor-induced conformational changes making it difficult to block
with neutralizing antibodies.

The ineffectiveness of previously developed vaccines primarily stems


from two related factors:

First, HIV is highly mutable. Because of the virus's ability to


rapidly respond to selective pressures imposed by the HIV structure cycle zh
immune system, the population of virus in an infected
individual typically evolves so that it can evade the two
major arms of the adaptive immune system; humoral (antibody-mediated) and cellular
(mediated by T cells) immunity.
Second, HIV isolates are themselves highly variable. HIV can be categorized into multiple
subtypes with a high degree of genetic divergence. Therefore, the immune responses raised by
any vaccine need to be broad enough to account for this variability. Any vaccine that lacks this
breadth is unlikely to be effective.

The difficulties in stimulating a reliable antibody response has led to the attempts to develop a vaccine that
stimulates a response by cytotoxic T-lymphocytes.[8][9]

Another response to the challenge has been to create a single peptide that contains the least variable
components of all the known HIV strains.[10]

Animal model

The typical animal model for vaccine research is the monkey, often
the macaque. Monkeys can be infected with SIV or the chimeric
SHIV for research purposes. However, the well-proven route of
trying to induce neutralizing antibodies by vaccination has stalled
because of the great difficulty in stimulating antibodies that neutralise
heterologous primary HIV isolates.[11] Some vaccines based on the
virus envelope have protected chimpanzees or macaques from
homologous virus challenge,[12] but in clinical trials, humans who
were immunised with similar constructs became infected after later
2006-12-09 Chipanzees D Bruyere
exposure to HIV-1.[13]

There are some differences between SIV and HIV that may introduce
challenges in the use of an animal model. The animal model can be extremely useful but at times
controversial.[14]

There is a new animal model strongly resembling that of HIV in humans. Generalized immune activation as a
direct result of activated CD4+ T cell killing - performed in mice allows new ways of testing HIV
behaviour.[15][16]

NIAID-funded SIV research has shown that challenging monkeys with a cytomegalovirus (CMV)-based SIV
vaccine results in containment of virus. Typically, virus replication and dissemination occurs within days after
infection, whereas vaccine-induced T cell activation and recruitment to sites of viral replication take weeks.
Researchers hypothesized that vaccines designed to maintain activated effector memory T cells might impair
viral replication at its earliest stage.

Clinical trials
Several vaccine candidates are in varying phases of clinical trials.

Phase I

Most initial approaches have focused on the HIV envelope protein. At least thirteen different gp120 and gp160
envelope candidates have been evaluated, in the US predominantly through the AIDS Vaccine Evaluation
Group. Most research focused on gp120 rather than gp41/gp160, as the latter is generally more difficult to
produce and did not initially offer any clear advantage over gp120 forms. Overall, they have been safe and
immunogenic in diverse populations, have induced neutralizing antibody in nearly 100% recipients, but rarely
induced CD8+ cytotoxic T lymphocytes (CTL). Mammalian derived envelope preparations have been better
inducers of neutralizing antibody than candidates produced in yeast and bacteria. Although the vaccination
process involved many repeated "booster" injections, it was challenging to induce and maintain the high anti-
gp120 antibody titers necessary to have any hope of neutralizing an HIV exposure.

The availability of several recombinant canarypox vectors has provided interesting results that may prove to be
generalizable to other viral vectors. Increasing the complexity of the canarypox vectors by including more
genes/epitopes has increased the percent of volunteers that have detectable CTL to a greater extent than did
increase the dose of the viral vector. CTLs from volunteers were able to kill peripheral blood mononuclear
cells infected with primary isolates of HIV, suggesting that induced CTLs could have biological significance.
Besides, cells from at least some volunteers were able to kill cells infected with HIV from other clades, though
the pattern of recognition was not uniform among volunteers. The canarypox vector is the first candidate HIV
vaccine that has induced cross-clade functional CTL responses. The first phase I trial of the candidate vaccine
in Africa was launched early in 1999 with Ugandan volunteers. The study determined the extent to which
Ugandan volunteers have CTL that are active against the subtypes of HIV prevalent in Uganda, A and D. In
2015, a Phase I trial called HVTN 100, chaired by two South African researchers, tested the combination of a
canarypox vector ALVAC and a gp120 protein adapted for the subtype C HIV common in sub-Saharan
Africa, with the MF59 adjuvant. Those who received the vaccine regimen produced strong immune responses
early on and the regimen was safe.[17]

Other strategies that have progressed to phase I trials in uninfected persons include peptides, lipopeptides,
DNA, an attenuated Salmonella vector, p24, etc. Specifically, candidate vaccines that induce one or more of
the following are being sought:

neutralizing antibodies active against a broad range of HIV primary isolates;


cytotoxic T cell responses in a vast majority of recipients;
strong mucosal immune responses.[18]

In 2011, researchers in National Biotech Centre in Madrid unveiled data from the Phase I clinical trial of their
new vaccine, MVA-B. The vaccine induced an immunological response in 92% of the healthy subjects.[19]

In 2016, results were published of the first Phase I human clinical trial of a killed whole-HIV-1 vaccine,
SAV001. HIV used in the vaccine was chemically and physically deadened through radiation. The trial,
conducted in Canada in 2012, demonstrated a good safety profile and elicited antibodies to HIV-1.[20]
According to Dr. Chil-Yong Kang of Western University's Schulich School of Medicine & Dentistry in
Canada, the developer of this vaccine, antibodies against gp120 and p24 increased to 8-fold and 64-fold,
respectively after vaccination.[21]

Phase II

Preventive HIV vaccines

A recombinant Adenovirus-5 HIV vaccine (called V520) has been tested in two Phase 2b
studies, Phambili and STEP. On December 13, 2004, they began recruiting for the STEP study,
a 3,000-participant phase II clinical trial of a novel HIV vaccine, at sites in North America, South
America, the Caribbean and Australia.[22] The trial was co-funded by the National Institute of
Allergy and Infectious Diseases (NIAID), which is a division of the National Institutes of Health
(NIH), and the pharmaceutical company Merck & Co. Merck developed V520 to stimulate HIV-
specific cellular immunity, which prompts the body to produce T cells that kill HIV-infected cells.
In previous smaller trials, this vaccine was found to be safe, because of the lack of adverse
effects on the participants. The vaccine showed induced cellular immune responses against
HIV in more than half of volunteers.[2] V520 contains a weakened adenovirus that serves as a
carrier for three subtype B HIV genes (gag, pol and nef). Subtype B is the most prevalent HIV
subtype in the regions of the study sites. Adenoviruses are among the main causes of upper
respiratory tract ailments such as the common cold. Because the vaccine contains only three
HIV genes housed in a weakened adenovirus, study participants cannot become infected with
HIV or get a respiratory infection from the vaccine. It was announced in September 2007 that
the trial for V520 would be stopped after it determined that vaccination with V520 appeared
associated with an increased risk of HIV infection in some recipients.[23] The foremost issue
facing the recombinant adenovirus that was used is the high prevalence of the adenovirus-
specific antibodies as a result of prior exposure to adenovirus. Adenovirus vectors and many
other viral vectors currently used in HIV vaccines will induce a rapid memory immune response
against the vector. This results in an impediment to the development of a T cell response
against the inserted antigen (HIV antigens)[24] The results of the trial prompted the
reexamination of vaccine development strategies.[25]
HVTN 505, a Phase IIb study, was launched in 2009 but halted in 2013 due to meeting
requirements of futility. Although no further participants were vaccinated, the study is still in
follow-up.
In May 2016, Lawrence Corey and Myron Cohen of the HIV Vaccine Trials Network (HVTN)
and HIV Prevention Trials Network (HPTN) respectively partnered to launch the global
Antibody Mediated Prevention (AMP) trial (HVTN 703 and HVTN 704), the first phase IIb trial of
a monoclonal antibody for HIV prevention. Monoclonal antibodies (mAbs) are a passive
vaccination strategy. HVTN 703 and HVTN 704 test VRC01, a mAb that targets the CD4
binding site.[26]
In 2017, Janssen and the HVTN launched the phase IIb trial called HVTN 705/Imbokodo,
testing the mosaic vector vaccine Ad26.Mos4.HIV and the aluminum phosphate-adjuvanted
Clade C gp140 vaccines which are designed to prevent infection of all HIV subtypes around
the world.[27]

Therapeutic HIV vaccines

Biosantech developed a therapeutic vaccine called Tat Oyi, which targets the tat protein of HIV. It was tested
in France in a double-blind Phase I/II trial with 48 HIV-positive patients who had reached viral suppression on
Highly Active Antiretroviral Therapy and then stopped antiretrovirals after getting the intradermal Tat Oyi
vaccine.[28]

Phase III

Preventive HIV vaccines

There have been no passive preventive HIV vaccines to reach Phase III yet, but some active preventive HIV
vaccine candidates have entered Phase III.

In February 2003, VaxGen announced that their AIDSVAX B/E vaccine was a failure in North
America as there was not a statistically significant reduction of HIV infection within the study
population.
AIDSVAX B/E was a component, along with ALVAC, of the RV 144 vaccine trial in Thailand
that showed partial efficacy in preventing HIV. The AIDSVAX B/E and ALVAC vaccines
targeted the gp120 part of the HIV envelope. The study involved 16,395 participants who did
not have HIV infection, 8197 of whom were given treatment consisting of two experimental
vaccines targeting HIV types B and E that are prevalent in Thailand, while 8198 were given a
placebo. The participants were tested for HIV every six months for three years. After three
years, the vaccine group had HIV infection rates reduced by about 30% compared with those in
the placebo group. However, after taking into account the seven people who already had HIV
before getting vaccinated (two in the placebo group, five in the vaccine group) the difference
was 26%.[29] It was discovered that participants receiving vaccines in the RV 144 trial who
produced IgG antibodies against the V2 loop of the HIV outer envelope were 43% less likely to
become infected than those who did not, while IgA production was associated with a 54%
greater risk of infection than those who did not produce the antibodies (but not worse than
placebo). Viruses collected from vaccinated participants had mutations in the V2 region. Tests
of a vaccine for SIV in monkeys found greater resistance to SIV in animals producing
antibodies against this region. Therefore, further research is expected to focus on creating
vaccines designed to provoke an IgG reaction against the V2 loop.[30]
In 2020, the phase IIb-III trial HVTN 702/"Uhambo" found that ALVAC/gp120/MF59
vaccinations were safe, and caused no harm, but had no efficacy in HIV prevention in South
Africa. Vaccinations with the Uhambo vaccine regimen began late 2016 and stopped early
2020.[31]
In 2020, the Ad26.Mos4.HIV plus adjuvanted clade C gp140 vaccine regimen entered a phase
III trial called HVTN 706/"Mosaico". The regimen is a combination of an adenovirus vector
vaccine engineered against multiple global strains of HIV, and a protein vaccine.[32]

Therapeutic HIV vaccines

No therapeutic HIV vaccine candidates have reached phase 3 testing yet.

Economics
A July 2012 report of the HIV Vaccines & Microbicides Resource Tracking Working Group estimates that
$845 million was invested in HIV vaccine research in 2011.[33]

Economic issues with developing an AIDS vaccine include the need for advance purchase commitment (or
advance market commitments) because after an AIDS vaccine has been developed, governments and NGOs
may be able to bid the price down to marginal cost.[34]

Classification of possible vaccines


Theoretically, any possible HIV vaccine must inhibit or stop the HIV virion replication cycle.[35] The targets
of a vaccine could be the following stages of the HIV virion cycle:

Stage I. Free state


Stage II. Attachment
Stage III. Penetration
Stage IV. Uncoating
Stage V. Replication
Stage VI. Assembling
Stage VII. Releasing

Therefore, the following list comprises the current possible approaches for an HIV vaccine:

Filtering virions from blood (Stage I)


Biological, chemical and/or physical approaches for removing the HIV virions from the blood.

Approaches to catching the virion (Stage I-III, VI, VII)


Phagocytosis of the HIV virions.
Chemical or organically based capture (creation of any skin or additional membrane around the
virion) of HIV virions
Chemical or organic attachments to the virion

Approaches to destroying or damaging the virion or its parts (Stage I-VII)

Here, “damage” means inhibiting or stopping the ability of virion to process any of the Phase II-VII. Here are
the different classification of methods:

By nature of method:
Physical methods (Stage I-VII)
Chemical and biological methods (Stage I-VII)
By damaging target of the HIV virion structure:[36][37]
Damaging the Docking Glycoprotein gp120[38] (Stage I-III, VI, VII)
Damaging the Transmembrane Glycoprotein gp41[39] (Stage I-III, VI, VII)
Damaging the virion matrix (Stage I-III, VI, VII)
Damaging the virion Capsid (Stage I-III, VI, VII)
Damaging the Reverse Transcriptase (Stage I-VII)
Damaging the RNA (Stage I-VII)

Blocking replication (Stage V)


Insertion into blood chemical or organic compounds which binds to the gp120. Hypothetically, it
can be pieces of the CD4 cell membranes with receptors. Any chemical and organic alternative
(with the ability to bind the gp120) of these receptors also can be used.
Insertion into blood chemical or organic compounds which binds to the receptors of the CD4
cells.

Biological, chemical or physical approaches to inhibit the process of


phases
Biological, chemical or physical approach to inhibit the Attachment, Penetration, Uncoating,
Integration, Replication, Assembling and/or Releasing.

Inhibiting the functionality of infected cells (Stage VI-VII)

Inhibiting the life functions of infected cells:

Inhibiting the metabolism of infected cells


Inhibiting the energy exchange of infected cells

Future work
There have been reports that HIV patients coinfected with GB virus C (GBV-C), also called hepatitis G virus,
can survive longer than those without GBV-C, but the patients may be different in other ways. GBV-C is
potentially useful in the future development of an HIV vaccine.[40]

Live attenuated vaccines are highly successful against polio, rotavirus and measles, but have not been tested
against HIV in humans. Reversion to live virus has been a theoretical safety concern that has to date prevented
clinical development of a live attenuated HIV-1 vaccine. Scientists are researching novel strategies to develop
a non-virulent live attenuated HIV-1 vaccine. For example, a genetically modified form of HIV has been
created in which the virus's codons (a sequence of three nucleotides that form genetic code) are manipulated to
rely on an unnatural amino acid for proper protein translation, which allows it to replicate. Because this amino
acid is foreign to the human body, the virus cannot reproduce.[41]

See also
Cabotegravir
COVID-19 vaccine
HIV Vaccine Trials Network
World AIDS Vaccine Day

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External links
Vaccine Research Center (VRC) (https://web.archive.org/web/20070817112159/http://www.vrc.
nih.gov/)- Information concerning Preventive HIV vaccine research studies
NIAID HIV vaccine site (https://www.niaid.nih.gov/daids/vaccine/default.htm) (DAIDS)
Global Alliance for Vaccines and Immunization (GAVI) (http://www.vaccinealliance.org)
International AIDS Vaccine Initiative (IAVI) (http://www.iavi.org)
AIDS Vaccine Advocacy Coalition (AVAC) (http://www.avac.org)
U.S. Military HIV Research Program (MHRP) (http://www.hivresearch.org)
Investigation of first candidate vaccine (http://briandeer.com/vaxgen-aidsvax.htm)
Be the Generation - Information on HIV Vaccine Clinical Research in 20 American Cities (http://
www.bethegeneration.org)
AIDS.gov - The U.S. Federal Domestic HIV/AIDS Resource (https://www.aids.gov)
HIVtest.org - Find an HIV testing site near you (https://web.archive.org/web/19991123222842/h
ttp://hivtest.org/)
Potential HIV vaccine using adenoviridae vectors (http://adenovirus.com/potential-adenovirus-a
ids-vaccine.html)
Bit by Bit, Scientists Gain Ground on AIDS (https://www.nytimes.com/2019/03/08/health/hiv-aid
s-research.html) - The New York Times, March 8, 2019
[1] (http://www.treatmentactiongroup.org/cure/trials)
Genetic Immunity, Inc. (http://www.geneticimmunity.com)

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