An HIV vaccine will never work in isolation

In the event that control and elimination of HIV is realised in the next few years, maintaining this success is going to be hard without a vaccine. That is how the Director of the US’ National Institutes of Allergy and Infectious Disease Dr Anthony Fauci analysed the situation at the AIDS Vaccine 2012 conference which ended Wednesday (Sept.12) in the American city of Boston. “If you want to have [HIV] control and maintenance of control, elimination and maintenance of elimination, in my mind the science and behaviour will tell me that it will virtually impossible to get to the point of true control and elimination without a vaccine,” said Dr Fauci in a keynote lecture. 

While there are diseases that have been controlled and eliminated using only vaccines or non vaccine strategies like vector control in parts of the world, noted Fauci, HIV requires a combination of both vaccine and non vaccine approaches.

New prevention technologies like voluntary medical male circumcision, treatment as prevention, and Pre Exposure Prophylaxis among others in spectrum of prevention have proven to be efficacious and in some cases effective but remain unexpanded, according to Fauci. 

“With good implementation of non vaccine prevention you can certainly control the epidemic and you may even be able to control it in a way that is highly effective if the programmes are implemented in a very aggressive way,” he explained.

But according to Dr Fauci, the impact of a vaccine is going to depend on how effective the non vaccine prevention modalities will turn out, and the timing of the arrival a vaccine into the prevention spectrum.

In Dr Fauci’s analysis, guided by mathematical modelling, if a vaccine were to come on board in the short term, it would have a major impact on the pandemic, and less of an effect on control if it comes very late and the current prevention efforts remain static.

However, with no effective vaccine expected in the short term and many developing countries grappling with expanding the current prevention strategies, controlling the AIDS pandemic appears distant.

Hope is none-the-less not lost with a 2009 proof of concept for a vaccine following results from the RV144, a US Army-led clinical trial involving more than 16,000 adult volunteers in Thailand. These results showed that the prime-boost combination of ALVAC® HIV and AIDSVAX® B/E was safe and lowered the rate of HIV infection by an estimated 31.2 percent compared with placebo. 

Now, the lone current vaccine study dubbed HVTN 505, is set help scientists better understand the human immune response to vaccines, and how to develop vaccines that are better able to produce the best immune response.

Kakaire Ayub Kirunda - CNS

(The author is a senior journalist based in Uganda. He has written on health extensively for noted media such as The Monitor, The Observer, CNS among others. He is also the CNS Health Fellow 2012 and was one of the AIDS Vaccine Fellows 2012 in Boston)

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