HIV vaccine development, combination prevention, antiretroviral treatment top agenda as briefing eyes progress against 2.3 million new infections

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From left to right: Fredrick Sawe, MHRP, Christina Polyak, MHRP, Margaret McGlynn, IAVI, Carl Dieffenbach, NIAID.

With the wait for a vaccine against HIV stretching back to when the virus was first identified 30 years ago, how do you measure progress?

You can measure it against the time vaccine development has taken since the field began. Margaret McGlynn, who has been involved in the marketing of more than a dozen vaccines, can’t think of a vaccine that took less than 15 years to develop. The polio vaccine, she notes, took 50 years. “Imagine if they had given up,” she said earlier this week, before a Capitol briefing on The Role of HIV Research in Ending AIDS: New Developments in HIV Vaccine and Prevention Science.

You can look, as McGlynn also did, at the promising paths being pursued now, in AIDS vaccine research, tackling each of the obstacles that have made this quest challenging; that the virus changes, hides, and, attacking the immune system, compromises natural defenses.

You can look, as Dr. Christine Polyak of the Military HIV Research Program did, at the proof of concept that a vaccine can prevent HIV acquisition that emanated from the 2009-released results of the RV 144 Thai trial, that researchers are continuing to build on.

You can look, as Dr. Carl Dieffenbach did, at what he calls the guiding principles to HIV prevention research: that no single HIV prevention strategy will be enough, that HIV testing continues to be the single entry point to prevention, and that understanding the factors fueling HIV epidemics locally remains critical.

You also can look at the whole picture together of the progress made in HIV and AIDS care treatment and prevention since the advent of antiretroviral treatment as Dr. Fredrick Sawe of the Military HIV Research Program in Kenya did.

The picture he brought showed a boney toddler-sized girl named Jolene sitting smiling between her two grandmothers. She is smiling because she feels much better than she did the month before, when, like a baby, she didn’t have the strength to hold her head up. She is sitting between her two grandmothers because they are all the family she has left, the rest having been lost to AIDS, which she also has. That picture was taken in 2004, when she was 10 years old, Dr. Sawe said. He showed another picture of Jolene now, a strongly built 12th grader in a navy blue school uniform, who Sawe had to point out is “the one on the left” because she is indistinguishable now from her healthy classmates.

“That is one of the opportunities we have had,” he said. Treatment, he added has “destigmatized” HIV, proving that a healthy life with the virus is possible. But the quest for a vaccine, he added, has underscored “that treatment is a stop gap.”

impactAnd you can demonstrate, as McGlynn did with a modelling study, that same point — in the best case scenario all currently effective interventions reaching all who need them, or in the more likely event that they continue to meet just a fraction of the need — the epidemic will not taper off to manageable numbers in the foreseeable future without a vaccine.

“Vaccines are transformative,” she said. “Think what the world would be like if a measles vaccine had never been developed, if a polio vaccine had never been developed.”

The briefing Monday was a collaborative effort from amfAR, the Foundation for AIDS Research, AVAC, Global Advocacy for HIV Prevention, IAVI, and the IDSA Center for Global Health Policy, which produces this blog.

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