Will an HIV Vaccine Trial in South Africa End the AIDS Epidemic?

On April 23, 1984, the US Department of Health summoned a highly publicised press conference. They declared that scientists had made a remarkable discovery to identify the virus behind AIDS, the dreaded disease ravaging gay men across America at the time. A vaccine was promised "within two years" – before the disease could assume epidemic proportions across the globe.

How naive the world was in 1984.

32 years of failed attempts, 39 million deaths and a dwindling pot of research funds later, a vaccine which halts the spread of HIV still remains elusive.

But 2017 might change all of that. Scientists are making unprecedented attempts to bring us closer to the elusive HIV vaccine than we’ve ever been before.

2017: Endgame HIV?

Antiretroviral medicines have changed HIV from a fatal to a chronic disease. As of December 2015, 17 million people living with HIV were on this therapy. (Photo: The Quint)

Come January and nearly 5,400 sexually active people between the ages of 18 and 35 will be enrolled in a massive, controlled HIV trial.

And why is this clinical trial important?

For starters, it is the first potential HIV vaccine trial to happen after seven years. It is the closest we’ve ever been to a cure because this agent is a modified version of the previous vaccine candidate (RV144), which was 34 percent effective in the 2009 Thailand clinical trial.

For the uninitiated, the 2009 Thailand clinical trial was the only silver lining in the 30-year history of HIV vaccine research. It was the largest-ever trial, enrolled 16,000 people and tested a combination of two previously failed vaccines. The combination vaccine had cut HIV infection by 34 percent – which is pretty modest – but the glimmer of success proved that an HIV vaccine is a possibility some day, one day.

The agent in the new trial (due to begin in January), has shown promise on lab monkeys. It will be remarkable if it is even 50 percent effective on humans.

The results will only come out by 2020; currently, it is a titanic struggle against a very slimy enemy.

Why India Needs To Watch This Trial Closely

In the last two decades, four HIV vaccine candidates have made it to human clinical trials, none to the market. (Photo: The Quint)

The grim statistics first.

Even though the number of new infections are falling, India has the third-highest number of people living with HIV in the world – roughly 21 lakh according to government estimates. More than 68,000 Indians get infected every year.

The World Health Organization recommends the antiretroviral treatment for everyone infected with the HIV virus. Yet, with lack of funds, India’s National Aids Control Programme can provide free medication to only 36 percent patients – those in dire need with CD4 counts less than 500 units. This explains why more than half of all global AIDS-related deaths happen in India.

And then there is the growing threat of drug resistance in India. A WHO report found that only 67 percent of people infected with HIV continue their treatment after a year. The routine stock-out of the AIDS medication can be blamed, but the fact is that the HIV virus is slowly getting resistant, so that a vaccine cure is the only holy grail which can contain the AIDS epidemic.

The best news, though? South Africa, where the trial will take place, has the same HIV sub-type that India does: ‘C’. So any success there will be quickly translated back home without the need for another clinical trial or modification of the vaccine.

(Photo: The Quint)

Also Read: Here’s What This HIV Positive Person Has To Say

The Hurdles In the HIV Vaccine Trial

There are ethical concerns when people are involved in an HIV trial, given the nature of the infection. Also, animal trials aren’t too successful because, although the strain of HIV in monkeys is similar, it is not identical. (Photo: The Quint)

Scientists took more than 100 years to make a typhoid vaccine, 89 years for a whooping cough vaccine, 47 years for polio and 42 years for measles. Over the decades, the time lag for vaccine development has gotten remarkably shorter. It took only 16 years for a hepatitis B vaccine. But HIV is our trickiest viral foe.

HIV is so diverse that within a couple of months of infection, it mutates into thousands of millions of different versions. To top that, it attacks the body’s immune cells – the very agents that are designed to kill it.

There are really 30 million viruses, so everybody’s effectively infected with a different HIV virus!

Making a successful HIV vaccine is like trying to slash millions of different, moving targets. Oh, and they have the power to neutralise your sword too.

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Published: 29 Nov 2016,08:10 AM IST

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