Abstract
This review describes some of the major obstacles that have impeded progress in the development of an effective neutralizing antibody-based HIV-1 vaccine and explains why it may be possible to overcome these obstacles. A renewed interest in the B-cell response in HIV-1-infected individuals is emphasized. New assay technologies and access to large numbers of clinical specimens have permitted a detailed assessment of the neutralizing antibody response in HIV-1-infected individuals. Recent studies have demonstrated that B cells can be stimulated to generate high titers of broadly cross-reactive neutralizing antibodies against multiple genetic subtypes of the virus. Preliminary evidence suggests that some of these antibodies are directed against epitopes in the CD4 binding site on monomeric gp120, whereas many others are directed against epitopes that remain to be identified. The rationale for pursuing an effective neutralizing antibody-based HIV-1 vaccine is strengthened by the recent demonstration of potent neutralizing antibody responses in a subset of HIV-1-infected individuals. Information on how this response develops and what epitopes are targeted could provide the insights that are needed to design improved vaccine strategies.
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