The 2010 scientific strategic plan of the Global HIV Vaccine Enterprise Print E-mail
  
Tuesday, 07 September 2010 15:53
Commentary from Nature Medicine
Full article is freely available at
Nature Medicine
 
The Council of the Global HIV Vaccine Enterprise, Seth Berkley, Kenneth Bertram, Jean-François Delfraissy, Ruxandra Draghia-Akli, Anthony Fauci, Cynthia Hallenbeck, Madame Jeannette Kagame, Peter Kim, Daisy Mafubelu, Malegapuru W Makgoba, Peter Piot, Mark Walport, Mitchell Warren & Tadataka Yamada for Members of the Enterprise, José Esparza, Catherine Hankins, Margaret I Johnston, Yves Lévy & Manuel Romaris for Alternate members, Rafi Ahmed & Alan Bernstein for Ex-officio members
AffiliationsCorresponding author
Nature Medicine 16 , 981–989 (2010) doi:10.1038/nm0910-981 
 
An important moment in HIV vaccine research
HIV/AIDS remains one of humanity's greatest challenges. Since 1981, it has claimed over 25 million lives and is
currently responsible for over 2.5 million new infections worldwide each year1. Although progress has been made in
preventing new HIV infections and in lowering the annual number of AIDS-related deaths through comprehensive
prevention programs and increased access to antiretroviral therapy, the number of people living with HIV—now over 33
million—continues to grow1. Currently, only two out of five people who need treatment receive it, and even this modest
level of progress in treatment is in jeopardy, as the availability of donor funds plateaus or declines2. Whereas universal
access to treatment is an ambitious goal, the annual accrual of newly infected individuals who require treatment
testifies to the urgent need for more effective prevention strategies. Vaccines are the primary public health intervention
for dozens of infectious diseases worldwide; they are easy to administer and yield lasting effects. As one of the most
powerful tools for preventing infection against other infectious diseases, a safe, effective, accessible HIV vaccine is
therefore one of our greatest priorities—and one of science's greatest challenges.
The unique ability of HIV to evade and suppress the immune response, its extraordinary genetic diversity, the
properties of its envelope glycoprotein and the ability to establish systemic infection within days and to induce
dysfunction and death of the immune cells needed to mount a protective response have posed unprecedented
challenges for vaccine development3. Nonetheless, although a highly effective HIV vaccine remains elusive, we have
never been closer to the target. Among the most visible achievements of the past five years were the results of RV144,
the trial conducted in Thailand, that showed that a poxvirus-protein prime-boost combination provided modest (31%)
protection against HIV acquisition4. These results represent the first-ever demonstration of any level of efficacy in
preventing HIV acquisition in humans by a vaccine. Although many questions remain, the results of the RV144 trial
have brought renewed energy to the field and created a new lens through which to evaluate future priorities and set
strategic directions.
There have been other key advances in HIV vaccine research over the past five years. They include a growing
understanding of the role of the mucosa as a barrier to sexually transmitted HIV infection5, descriptions of the earliest
immunological responses in humans after acute HIV infection6, the demonstration that HIV infection in humans is
usually initiated by one or a very small number of founder viruses7, 8, the development of computational algorithms to
inform the design of unique mosaic immunogens to address the challenge of viral sequence diversity by achieving
maximum epitope coverage while preserving natural antigen expression and processing9, new insights into the
immunological and genetic basis for the ability of some people to control the virus or prevent virus acquisition (socalled
'elite controllers' and 'exposed but uninfected persons', respectively)10, 11, the first proof of substantive simian
immunodeficiency virus control by CD8+ effector memory T cells induced through vaccination12, the isolation of new
antibodies with broadly neutralizing activity from HIV-infected subjects13, 14, 15 and appreciation of the possible role of
non-neutralizing antibodies in protection16, 17, 18.
Progress in other areas of biomedicine, including the development of faster and cheaper DNA sequencing, highthroughput
and computational technologies, will increasingly affect the progress of HIV vaccine research and
development. Last, although two large-scale human efficacy trials—STEP and Phambili—failed to confer protection19,
further analysis of these trials has influenced current thinking about the direction of HIV vaccine design, development
and clinical evaluation20, 21.
It is now incumbent upon the field to translate the opportunities created by these developments into a safe and
effective HIV vaccine suitable for use in populations with markedly different epidemiological, social, genetic and
behavioral characteristics. This next stage in HIV vaccine research requires a strengthened global strategy that
incorporates current efforts and encourages new and existing partners from high-, low- and middle-income countries to
embark on a shared scientific agenda.
...
Full article freely available at Nature Medicine
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