Durable end to the HIV/AIDS pandemic likely will require an HIV vaccine

Durable end to the HIV/AIDS pandemic likely will require an HIV vaccine

WHAT

Despite remarkable gains in the treatment and prevention of

HIV infection, development of an effective HIV vaccine likely will be necessary

to achieve a durable end to the HIV/AIDS pandemic, according to a new

commentary from Anthony S. Fauci, MD, director of the National Institute of

Allergy and Infectious Diseases (NIAID), part of the National Institutes of

Health.

Theoretically, effective global implementation of existing

HIV treatment and prevention tools could end the HIV/AIDS pandemic.

Antiretroviral therapy that suppresses HIV both benefits the health of those

living with HIV and prevents viral transmission to their HIV-negative sexual

partners. Additionally, strategies such as pre-exposure prophylaxis (PrEP) can

effectively prevent HIV acquisition among people at high risk for infection.

However, from a practical standpoint, ending the HIV/AIDS

pandemic without a vaccine is unlikely. Despite extraordinary progress in

implementing HIV testing and treatment, substantial gaps remain. Globally, more

than 17 million people living with HIV are not receiving antiretroviral

therapy. This is compounded by the continuing high rate of new infections, an

estimated 1.8 million worldwide in 2016 alone. Modeling studies have suggested

that the wide geographic dispersion of people, especially in certain rural

areas, would make it extremely difficult to reach all those who need HIV

treatment and prevention services. In addition, the economic resources needed

to leverage HIV treatment and prevention across the globe continually increase

as people become newly infected.

Dr. Fauci writes that even a modestly effective HIV vaccine

could substantially slow the pandemic, if deployed alongside current treatment

and prevention efforts. Because the immune system mounts an inadequate

protective response against HIV, an HIV vaccine most likely will not be as

effective as proven vaccines used to control or end global outbreaks, such as

yellow fever and polio vaccines, which are nearly 100 percent effective. According

to modeling studies, if current HIV treatment and prevention efforts are

sustained and an HIV vaccine that is at least 50 percent effective is developed

and deployed, the pandemic could be curbed.

It is critical to continue and accelerate a robust research

effort to develop an HIV vaccine that is at least moderately effective, while

also aggressively scaling up the implementation of current treatment and

prevention tools, Dr. Fauci concludes.

ARTICLE

AS Fauci. An HIV vaccine is essential for ending the HIV/AIDS pandemic. Journal

of the American Medical Association DOI: 10.1001/jama.2017.13505 (2017)