AIDS vaccine research - Time to call it a day?

AIDS prevention research has hit a major road block. More than 150 recent prevention trials including vaccine and microbicide candidates failed to protect trial participants against HIV infection. It is inevitable that the question is asked: Is there ever a point in time where we should concede defeat and abandon any further HIV vaccine and HIV microbicide trials?

With the death toll standing at 25 million lives lost prematurely to AIDS, and 33 million people worldwide currently living with HIV, the unpleasant truth is we have no choice other than to press ahead with further trials. I am not a great fan of Winston Churchill, but his famous remark, ‘Never give in. Never give in. Never, never, never’ seems to be the only appropriate response to the vaccine/microbicide trial question in the age of AIDS.

AIDS drugs have become more sophisticated, and no one knows for sure how long people will be able to cope with the side effects of such powerful agents. Truth be told, while new drugs are being developed continuously, we are barely ahead of the ever-mutating virus. Are we ahead at all, or are we falling further behind? For every one person bring treated in the developing world, roughly five new people become infected. It is far from clear that we can win the numbers game.

Even though significant inroads have been made, it remains that the vast majority of people in developing countries who could clinically benefit from AIDS drugs have no access to the life preserving medications that continue to be brought to the market.

While AIDS vaccine trials continue unabated, so do the equally unsuccessful microbicide trials. Microbicide trials are described by some as the politically correct brother of the better funded AIDS vaccine trials. Their scientific rationale seems as shaky, if not shakier than those of vaccine candidates, yet they continue because they are seen as the last best hope for women in developing countries to protect themselves against infection. The trouble is that so far all these trials have achieved so far is an increase in the number of women who have become more susceptible to an HIV infection as a result of their trial participation.

Proponents of the defeatist stance, including Homayoon Khanlou and Michael Weinstein of the AIDS Healthcare Foundation, the largest provider of HIV/AIDS medical care in the USA, argue that instead of continuing to squander hundreds of millions of dollars on a futile quest for an HIV vaccine, the focus should shift to spending on the prevention, testing and treatment of AIDS.

But we will only ever know after a trial whether or not it has been futile. At this point in time there is no real reason to assume such trials will necessarily fail. What we should be focusing on instead are other ethical concerns such as the provision of care to people who seroconvert during trials, or people who become more susceptible to an infection due to their trial participation. We have to ensure that no trial participant is left without adequate clinical care at the very minimum. The talk about pulling the plug on HIV vaccine and microbicide trials needs to end sooner rather than later.

Interesting developments on the AIDS frontiers

I suspect you might have missed one or another of the big-news events on the AIDS fronts. Nobel laureate and current president of the AAAS David Baltimore used his keynote address to the AAAS meeting this year to suggest that there's a distinct possibility (not to say high likelihood) that we won't be getting a successful preventive HIV vaccine ever.

The excitement over findings that male circumcision might drastically reduce HIV risk should be somewhat cooled down, because another study since discovered in the USA that that actually wasn't the case for circumcised black and latino men who have sex with other men.

Another piece in the puzzle is a consensus statement from HIV/AIDS specialists in Switzerland who declared that it is impossible for an HIV infected person to pass the infection on to his or her sex partners if she's on HAART and has a viral load of less than 40 copies/ml. In other words, successful medical control of the infection renders infected people non-infectious for all intent and purposes.

Indeed, it has even been suggested by some scientists that pre-exposure prophylaxis might work (ie people who are at high risk of getting infected should take AIDS drugs as a preventative means). Of course, today's AIDS drugs are essentially chemotherapeutics, so to suggest that healthy people at risk of HIV infection take them permanently (or at least while they engage in high-risk activities) seems a difficult to accept proposition, yet it might well work (just as post-exposure prophylaxis works) while there's no vaccine.

However, all of these discussions seem to be indicative of an ever-growing desperation among HIV specialists resulting from the absence of a working vaccine. The ongoing AIDS epidemics among the peoples of Southern Africa and the Caribbean suggest strongly that only so much can be achieved by throwing condoms at people... and so much, quite possibly, just isn't good enough. This is not the type of politically correct message the safe sex industry likes to hear, but surely the pandemic would not continue to run at such high speed if the safe sex campaigners had made significant inroads during the last few decades. To be fair, it might be that safe sex is currently more or less all there is, but it would be wrong to pretend that it is 'working' as they say.

Of course, living in North America these days, I do have access to truly bizarre religious cable channels. This crowd is actually trying to persuade Africans not to use condoms and instead be abstinent. I watched a fundraising programs from them the other day, in which these folks deliberately spread falsehoods such that condoms have little holes in them thru which HIV can spread anyway, and other such nonsense. It boggles the mind. The biggest lies were peddled by a guy in a black (long) skirt with a white collar - he claims, of course, to never have had sex in his whole life. These are the types of characters that, in yet another wave of Western colonialism, travel to Africa and try to persuade rural Africans to forgo the use of condoms when they've sexual intercourse.

Scary stuff. Well, it seems there's always someone out there to make matters worse, and the religious squad is never far from where that happens. As ever, due to some waffle about religious freedom, they cannot even be held accountable in a court of law for spreading lies.

UNAIDS goes head-to-head with Catholic Church

Reuters reported this story yesterday:

Global Challenges | Catholic Church's Opposition to Condom Use Contributes to Spread of HIV in Latin America, UNAIDS Official Says

[Oct 24, 2007]

The Roman Catholic Church's opposition to condom use is contributing to the spread of HIV in Latin America, Alberto Stella -- UNAIDS coordinator for Honduras, Nicaragua and Costa Rica -- said on Monday, Reuters reports.

"In Latin America, the use of condoms has been demonized, but if they were used in every relation, I guarantee the epidemic would be resolved in the region," Stella said. He added that youth "start to be sexually active between 15 and 19 without sex education" -- a factor that contributes to the spread of HIV. In addition, evidence indicates that promoting abstinence is "not working," according to Stella.

About half of the 1.1 billion Catholics worldwide live in Latin America, and the Roman Catholic Church "holds sway" in the region, Reuters reports. About 1.7 million people in Latin America are living with HIV/AIDS. The number of new HIV cases in the region increased to 410,000 in 2006 from 320,000 in 2004, according to UNAIDS (Reuters, 10/23).