AIDS
Vaccine Fails Test
Racial Breakdown Draws Questions
by
Thomas H. Maugh II & Denise Gellene - Los Angeles Times
February 28, 2003
Although the first clinical trial of an AIDS vaccine proved to
be an overall failure, researchers were sharply divided Monday over data
from a subset of participants that seemed to offer hope for treating
blacks and Asians.
After a five-year trial, officials of Brisbane, Calif.-based VaxGen
Inc. were forced to concede that their prototype vaccine, called Aidsvax,
provided no protection to the vast majority of the people who received
it.
"Overall, what we see is that the trial failed," said VaxGen
President Dr. Donald Francis.
But opinions varied sharply about the meaning of results obtained
with a group of blacks and Asians representing less than 10 percent of
the more than 5,400 people who took part in the study. To some experts,
they represented the most important--or at least the most
intriguing–part of the findings.
Among that small group of Asians, blacks and other non-Latino
minorities, the vaccine reduced the infection rate by 67 percent. Among
blacks alone, the results were even better–a 78 percent reduction in
infections.
"These results are promising. The trial provides clear evidence that
a vaccine can work," said Dr. Peter Piot, executive director of the
United Nations AIDS agency.
Others, however, were sharply critical.
Dr. John P. Moore of the New York Weill Cornell Medical Center argued
that the racial data are "a statistical artifact" based on the small
number of individuals involved. There is, he added, "no biological
reason based on how the vaccine works that race would make a
difference."
He charged that VaxGen officials "played the race card ... because
(the company) had to show some results to its public investors."
Martin Delaney of the San Francisco-based AIDS group, Project Inform,
agreed, noting, "This is at best premature and irresponsible data
reporting. ... It would do a great deal of harm to stir up hopes for
selected groups over a vaccine that has proven ineffective overall."
But Phill Wilson, executive director of the Black AIDS Institute,
cautioned that the data might not have been interpreted correctly. The
majority of the blacks in the study were women, he noted, while all of
the Caucasians were males. "This might be a gender effect rather than a
racial one," he said.
However results with the subgroup are interpreted, people should not
be overly discouraged by the findings, said Dr. Seth Berkley of the
International AIDS Vaccine Initiative. Although most observers did not
expect significant protection from Aidsvax, he said, "scientists remain
confident that an AIDS vaccine is possible. Alternative AIDS vaccines,
employing different design strategies, are now in development and some
have already entered clinical trials."
Some of those look much more promising, he said.
Aidsvax is a vaccine in the classic mold, designed to stimulate the
production of so-called neutralizing antibodies that bind to the virus’
surface and prevent it from attacking host cells. To achieve this, the
company’s scientists genetically engineered a surface protein, called
gp120, found in two strains of HIV. This protein is then injected into
the recipient in an effort to stimulate antibody production.
For the trial, researchers enrolled 5,108 gay men and 309 women at
high risk at 59 centers in the United States, Canada, Puerto Rico and
the Netherlands. All were HIV-negative at the beginning of the trial.
Two of every three participants were randomly selected to receive at
least three injections with the vaccine, while the rest received an
equal number of sham injections. All were given counseling about risk
avoidance. All were monitored for three years.
Even company officials did not expect the vaccine to be highly
protective. Francis had noted on many occasions that he would be
overjoyed if it proved to be 30 percent to 50 percent effective. As a
measure of how desperate the world AIDS situation is, the Food and Drug
Administration had said it would approve the vaccine even if it were
only 30 percent effective. Most approved vaccines, in contrast, are 80
percent effective or higher.
But even the 30 percent figure proved to be wildly optimistic.
Company officials said Monday that the reduction of infection produced
by the vaccine was 3.8 percent for the entire group. The good news, they
added, was that there were no adverse effects other than local
tenderness at the site of the injection.
There was no evidence of increased susceptibility to infection among
those who received the vaccine, and no evidence of an increased rate of
progression among those who received the vaccine and subsequently became
infected.
Company officials said the increased efficacy among non-Latino
minorities was most likely real–there is only a one in 100 chance that
it is coincidental. Phillip Berman, the company’s vice president of
research and development, also added that the level of protective
antibodies was higher in those groups than in whites.
But critics noted that among the 498 non-Latino minority
participants, only 29 people became HIV-positive--17 of whom received
the vaccine and 12 of whom did not. Among the 314 blacks, 13 became
HIV-positive–four who received the vaccine and nine who received
placebos.
"The numbers of participants in this group are too small to draw any
conclusions about the vaccine’s effects in this subpopulation," said
Chris Collins, executive director of the AIDS Vaccine Advocacy
Coalition, who criticized the company for releasing the data in this
form.
"Such premature conclusions run the risk of raising false hopes in a
world desperate for an AIDS vaccine," he said.
Researchers are likely to argue about these results for months,
especially because there is no other data available. The next major
results that are expected are from a slightly different formulation of
Aidsvax that is being tested among about 2,500 drug abusers in Thailand.
Those results are expected in June.
