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Ten years after the former US president Bill Clinton predicted the arrival of a vaccine for AIDS within a decade, one of the world's leading HIV researchers has admitted he is pessimistic about the prospects of achieving an effective vaccine in the near future.
At a briefing in London last week of the International AIDS Vaccine Initiative, Robin Weiss of University College London said that the enormous variation among HIV viruses was continuing to prove a huge stumbling block.
“I'm the pessimistic person on the panel,” Professor Weiss said, noting that there were as many or more genetic variants of HIV in the body of one infected person as there were different types of flu virus in the whole world.
“I think that we will get there in the end, but not because there is a vaccine A, B, or C in the background that we have in mind,” he added.
He said that a disproportionate amount of the resources deployed in the fight against AIDS had been poured into research into drugs.
“Therapeutics have developed faster [than a vaccine], because lots of people with HIV have said, ‘What about us?' But we've got to focus on the future generations.”
Dwayne Koff of the International AIDS Vaccine Initiative, who organised the briefing to mark world AIDS vaccine day—and the 10th anniversary of President Clinton's prediction—admitted that variation among HIV strains and a patchy understanding of what the human body needed to protect itself from the virus were holding back vaccine research.
But he said the fact that 11000 new infections were occurring every day meant that the hunt for a vaccine remained imperative.
Hope currently rested on two vaccines now in phase III trials, he said. One is being tested on 2000 people in Thailand, with US government help. The other, a Merck vaccine, is being tested on 3000 people in different continents. Results from both trials are expected in 2009.
Dr Koff said he was more optimistic than Professor Weiss. He admitted, however, that the first HIV vaccines to get licences would almost certainly not offer complete protection against infection. Instead, he thought that emerging vaccines might prevent some infection or reduce the virulence of HIV disease in people who were infected.
“If you can cut down viral load, the assumption is you can slow the progress of the disease,” he said.
His colleague Jill Gilmour said that even if initial vaccines were not successful, countries in the developing world would, by testing the vaccines, accrue the health infrastructure needed to dispense the more effective vaccines that arrived later.
Dr Koff said that the huge increase in funds for basic research from the Bill and Melinda Gates Foundation would also hasten the arrival of a vaccine for HIV.
Ten years ago $100m (£50m; €74m) was spent each year on research into a vaccine; today that figure has risen to $800m. However, Dr Koff noted that “much more” money was needed, because of the huge cost of clinical trials and the need to test one vaccine in different regions.
In the past 20 years AIDS has claimed 40 million lives, says UNAIDS, the joint United Nations initiative on HIV and AIDS. Last year 2.9 million people died from AIDS, 2.1 million of them in sub-Saharan Africa. Over 20 million people are currently thought to be infected with the virus.