HIV prevention: on the verge of transformation

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A look at the recent AIDS Vaccine 2012 Conference shows range of prevention developments

The following is a guest post from Margaret McGlynn, president and CEO of the International AIDS Vaccine Initiative (IAVI) and William Snow, director of the Global HIV Vaccine Enterprise.

More than 1,000 HIV researchers and other professionals involved in HIV prevention recently converged on Boston from all corners of the world to attend AIDS Vaccine 2012. As might be expected, there was no shortage of brilliant science at the event, though we would be hard pressed to pick out any single discovery that stole the show.

That is a good thing. There has been so much progress in every aspect of HIV prevention research over the last three years that they had plenty to report. The Ragon Institute, the Global HIV Vaccine Enterprise and the Harvard Center for AIDS Research, which co-hosted the event, expected as much and made sure that advances in vaccine discovery and development were placed in the context of breakthroughs in everything from pre-exposure prophylaxis to cure research.

Indeed, it is increasingly clear that defeating HIV will require the combined application of a number of interventions. As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, pointed out in his plenary talk, the proper implementation of a range of non-vaccine preventive tools and strategies has the potential to turn the tide of the pandemic. But, he noted—reflecting a growing consensus within the field—that the elimination and, ultimately, eradication of HIV will only be achieved by the additional and widespread deployment of preventive vaccines against the virus.

If the AIDS Vaccine 2012 conference was any indication, researchers are making substantive progress toward that goal. Buoyed by the first proof of concept for an HIV vaccine, provided by the RV144 trial in Thailand in 2009, the field has aggressively worked to refine and move new vaccine candidates into human trials. Researchers reported data from the unprecedented collaborative effort to unearth the immunological underpinnings of the protection observed in the Thai trial, confirming previous findings about the immune responses that correlated with vaccine efficacy. Others highlighted progress in ongoing efforts to engage the cell-mediated response of the immune system, which will likely have to be awakened to control HIV infection by immunization. But perhaps no other area received as much attention as the inquiry into the generation and specificity of dozens of new and potent broadly neutralizing antibodies against HIV.

This expanded and exciting effort is a critical shift in the direction of HIV vaccine R&D, especially since research presented at the conference underscored the importance of stopping HIV at the earliest stages of infection, hours after it enters the body. A vaccine that trains the immune system to target those localized viruses will very likely have to elicit just such protective antibodies.

Further, given how urgently the world needs an AIDS vaccine, the availability of broadly neutralizing antibodies opens the door to proof-of-concept studies examining the potential of antibody-based HIV vaccine strategies. Trevor Mundel, head of the Global Health Program at the Bill & Melinda Gates Foundation (BMGF), reminded attendees that the financial risk and long timeframes associated with moving a vaccine from preclinical through clinical testing has long hampered HIV vaccine development. The field, he argued, must devise new technologies and strategies to more quickly assess the potential efficacy of its vaccine concepts. Candidates that elicit broadly neutralizing antibodies are most probably a way off from clinical assessment but, as Mundel noted, they certainly fall into that category. In fact, a trial examining the ability of one such antibody to provide passive protection from HIV is already well along in planning.

Mundel also observed that if there’s one thing he has learned from his vantage at BMGF, it is that HIV researchers are probably “the most passionate, activist scientific community in the global health space.” That passion too was on abundant display in Boston last week, as was the sheer diversity and variety of research conducted by those involved in the AIDS vaccine effort. Many more would doubtless have come if they could. This is why conference hosts have loaded most of the talks and posters for free viewing on the Internet. We invite you to visit this website and share in the hearty feast of science it offers.

We hope that the website sees plenty of traffic from across the globe in the next few months. After all, scientific partnership across borders and oceans has long been a hallmark of HIV vaccine development. It has what brought the field to where it is now: on the verge of a transformation.

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