Towards an AIDS vaccine: the role of primate models.

Abstract

AIDS has become a global pandemic comparable in its impact to the great plagues of history; an estimated 30 million people worldwide are infected with HIV, approximately 15,000 people are infected each day, and AIDS is almost 100% fatal when untreated. Although highly effective antiretroviral drugs are available to treat HIV/AIDS, the approximately $10,000 cost per person treated makes the therapy available in only relatively wealthy countries. The development and general dissemination of an effective vaccine against HIV/AIDS is the only possibility of controlling the pandemic in countries where most infections are currently occurring. Efforts to develop a vaccine began immediately after HIV was identified in 1983-84, and led to the production of a first generation of vaccines tested in humans. However, it appears that these first generation vaccines will not confer the necessary protection against HIV, but more will be learned of their potency after the completion of efficacy trials which will probably begin during 1998. The disappointing immunological and protective response of humans to the recombinant env proteins has discouraged many biotechnology and pharmaceutical companies from pursuing the research and development of AIDS vaccines. The author discusses the use of primate models in the study of candidate immunogens which may be developed into vaccines for the protection of humans. Specifically, he considers whether it is possible or necessary to induce sterilizing immunity against SIV or HIV, which immune mechanisms are involved in the protection of vaccinated primates, the role of mucosal immunity in an AIDS vaccine, and the likely components of a program for vaccine development.