Although much progress has been made in combating the global HIV/AIDS pandemic, to halt new infections and end the pandemic, a combination of non-vaccine and vaccine prevention modalities will be needed. Even with these tools, significant implementation gaps must be closed, including the targeted deployment of proven prevention methods to the populations that need them most, says Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Fauci addressed a special session at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada.
Fauci described how proven medical interventions have been successfully applied to a range of prevention strategies, including antiretroviral therapy (ART), medical male circumcision, daily pre-exposure prophylaxis (PrEP) and treatments that prevent mother-to-child HIV transmission. He also will review how treatment of HIV-infected people early in the course of their infection can dramatically reduce the risk of transmitting HIV to an uninfected sexual partner, while simultaneously protecting the health of the infected individual. Although these interventions can dramatically reduce the rate of HIV infection, some individuals find it difficult to adhere to ART, which presents obstacles to optimal implementation of these programs.
Several approaches towards the development of an HIV vaccine are currently being pursued, Fauci notes. The Pox-Protein Public-Private Partnership (P5), of which NIAID is a member, is exploring strategies in South African trials to amplify the encouraging results from RV 144, an HIV vaccine clinical trial in Thailand that resulted in the first modest signal of efficacy. Scientists also are investigating the potential use of broadly neutralizing antibodies directed against HIV which are elicited in natural infection in some HIV-infected individuals. These antibodies already are being tested for use via passive transfer in treatment and prevention of transmission. Scientists in pursuit of an HIV vaccine are building on this work, designing techniques to elicit these antibodies through sequential stimulation of the immune system with specifically designed immunogens.
Better application of proven prevention technologies can help drive down the global incidence of HIV. If these methods can be combined with an effective vaccine, the end of the HIV/AIDS pandemic could be within reach, according to Fauci. However, to realize that potential, substantial implementation gaps will need to be closed. For example, evidence shows that HIV risk is not uniformly distributed; certain high-transmission areas have disproportionately elevated rates of incidence as compared to neighboring districts. Fauci said that by focusing on these areas, understanding the drivers of HIV risk and deploying prevention technologies, HIV transmission could be decreased dramatically, finally halting the spread of HIV.
Source: NIH/National Institute of Allergy and Infectious Diseases