The first session that I attended was entitled HIV Vaccines: The Path forward.

The first session that I attended was entitled HIV Vaccines: The Path forward.

This is an appropriate title for this session considering the beating that HIV vaccine researchers and vaccine planners have taken over the last 2 years. The Merck-Government (STEP) vaccine failed miserably. Why, poor planning, poor implementation, poor science, politicians involved in the trial, failure to study the behaviors of Africans, and finally the desire by the past American administration to solve the HIV/AIDS problems as a lasting legacy to George Bush. All of this failed. Dr. Anthony Fauci put a halt on all government sponsored Vaccine trials because of those failures and he recommended that we go back to the drawing board, to do basic research, to restudy the virus and the immune system. That is what Vaccine researchers are doing no with mixed success.

The first talk was given by Miller of the RV 144 vaccine update from the Thailand based vaccine trail of 2 different vaccine candidates used to vaccinate people at the same time,, the ALVACX and the AIDSVAC candidates. People were randomized to get either both of these candidate vaccines or none in the placebo arm. Thee was a large number of people that participated in Thailand, 26,700, and the trial was ;powered in the right way, but although it showed some efficacy briefly, most people would consider it a failure in protecting people from HIV.

There then was another talk analyzing the STEP vaccine trial and why people continue to analyze this failure is beyond me. This talk was a failure also.

There followed a talk on therapeutic vaccine by the ACTG termed ACTG 5197. Therapeutic vaccines are given to people who are already infected. The study showed a 1/4 log benefit in the therapeutic vaccine. Again one has to question why in this day and age of excellent antiretroivrial drugs why anyone would opt for this trial when they could opt for another antiretroviral drug if they were failing treatment.

An interesting talk followed on using dendrite cells as the vector for autologous HIV. Dendritic cells are an excellent cell in the body where the virus multiplies. So using dendrites as a vector for delivering the vaccine candidate is a good idea but again no positive results from this study.

Finally two late breading talks were given.The first used a pox-virus based HIV vaccine requiring 3 injections of this DNA vaccine. This was a phase 1 study to show safety first. Immunogenicity of this vaccine was increased with 3 injections of this DNA based vaccine. DNA vaccines are the hottest thing going to find a preventative vaccine for HIV. These people are on the right tract.

Finally there was a talk on GM-CSF for use as an adjuvant to a candidate vaccine. These also would be used with DNA as the vector. This study was done in macaque monkeys but it is something worth watching as the field of vaccinology proceeds.

All in all the data for a protective vaccine was pretty disappointing. I do not believe there will ever be a vaccine found for HIV, The virus mutates too much, there are two many different types of the HIV virus. We must look to other means of prevention.