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Note from BLFisher:
This article details the biological factors which make
it so difficult to
develop an AIDS vaccine that will be safe and
effective for all individuals
and all populations in the world. And yet, because the
past is prologue,
there is no question that when an AIDS vaccine is
developed and licensed as
safe and effective, it will be mandated for everyone.
http://www.SeattleTimes.com
Sunday, August 26, 2001 - 12:00 a.m. Pacific
Scientists buoyed by series of tests for AIDS vaccine
By Daniel Q. Haney
The Associated Press
ATLANTA The
scientists trying to create a vaccine to prevent AIDS suddenly
seem optimistic, even bullish, words not heard much in
this perennially
gloomy field.
AIDS Q&A
Q: How soon do researchers think an AIDS vaccine might
be available?
A: If the only one in large-scale testing fails, it
will be at least six to
10 years.
Q: Will it prevent everyone from contracting AIDS?
A: Probably not. The most-promising vaccines under
development don't prevent
HIV infection; most would keep the virus under control
so it doesn't cause
illness.
Q: Would the vaccine prevent AIDS from spreading?
A: Probably not completely. Usual safeguards using
condoms and drug users
not sharing needles
still would be recommended.
Q: Would such a vaccine be given to everyone?
A: No. Until a vaccine is perfected and found to
prevent HIV infection, it
probably would be used on target populations at very
high risk, such as drug
addicts.
The Associated Press
Many researchers for the first time appear confident a
vaccine is possible.
More than anything else, monkeys are responsible for
the change in attitude.
Scientists for two decades have used monkeys to test
theories about AIDS
treatment and prevention. But a vaccine that would
safely protect a monkey
from dying of AIDS was elusive. Until now.
Now there are monkeys such as Godot, a blond,
4-year-old macaque living in
the level-2 biohazard-containment facility at the
Yerkes Regional Primate
Research Center on the leafy fringes of Emory
University. More than a year
ago, Godot received a big dose of SHIV, an especially
nasty, lab-made
amalgam of HIV and SIV, the human and monkey versions
of the AIDS virus. He
ordinarily would have been dead in six to eight
months.
Anyone entering Godot's living space must dress head
to toe in protective
clothing, because SHIV circulates in his bloodstream.
But his curious, alert
stare at visitors peeking through a window shows he is
outwardly unscathed.
Godot is infected, but otherwise healthy.
Seven months before he was infected, Godot received an
experimental new AIDS
vaccine, one that experts hope will be the model for a
shot to control the
worldwide epidemic.
Two other variations have been tested on monkeys at
Harvard Medical School
and Merck, the U.S. drugmaker, with similar results.
The Merck vaccine is in
first-stage human testing, and the Yerkes and Harvard
versions should start
within six months.
Vaccine discovery has been a notoriously discouraging
area of AIDS research.
But, thanks to this impressive series of monkey
experiments, many
researchers have grown upbeat in the past year.
An AIDS vaccine is still no sure bet, they say. But
many think they are at
least on a rational path toward finding one.
Chances of success? "Very good," predicted
Harriet Robinson, who oversaw
experiments involving Godot and about 80 other
monkeys. Why? "Because of the
monkeys," she said. "We are not all that
different from monkeys."
How different humans are from monkeys is key and a
matter of debate among
scientists.
Still, similarities are striking. In both monkey and
man, the virus destroys
its victims' cells, a crucial branch of the immune
defenses. In monkeys, the
vaccine seems to blunt this attack. Maybe it will in
people, too.
"Suddenly there is a sense for the first time
that perhaps we have the tools
in hand today to make a substantial impact on the
dynamic of the HIV
epidemic," Harvard's Norman Letvin said.
"Now there is an absolute stampede
to get these technologies into humans and ask the
question: Can we translate
these monkey findings into the human situation?"
Researchers hope to know soon whether these
experimental shots launch the
same, early immune-system defenses seen in vaccinated
monkeys. This would be
an encouraging hint of the vaccine's eventual power.
Some answers could be
offered at an international AIDS vaccine conference
early next month.
However, vaccine development is frustratingly slow.
Even if all goes
flawlessly, Yerkes' Robinson estimated that
large-scale experiments with her
vaccine won't begin until 2005. Many estimate these vaccines
are still a
decade or more away.
With clear answers so far off, is all this optimism
realistic?
"I ask myself whether it is justified based on
the science," said Peggy
Johnston, assistant director for AIDS vaccines at the
National Institute of
Allergy and Infectious Diseases. "And my
conclusion is yes."
One reason is that scientists have lowered the bar.
Until now, all useful
vaccines prevented infections. However, the human
immune system cannot turn
back an HIV infection, and no one knows how to make a
vaccine that
accomplishes something the human body cannot do for
itself.
So the new vaccines are designed to accomplish the
next-best thing: Train
immune defenses to hold an infection in check without
preventing it
entirely.
"For a long time, people assumed that the only
successful vaccine would
completely prevent infection," said Robert
Schooley of the University of
Colorado. "The new studies suggest that a vaccine
might also have a
moderating influence on the disease process
itself."
Scientists agree that blocking an infection requires
the production of
powerful antibodies. This is how standard vaccines
work: They show the
immune system a protein that is unique to the germ. If
the bug ever enters
the body, the defenses will blaze back with antibodies
that latch onto the
protein, blocking the germ and destroying it.
HIV, however, is a moving target. It mutates so
rapidly that it constantly
changes proteins on its surface. So a vaccine that
triggers an attack
against one strain of HIV may be powerless against
another. Furthermore, the
virus covers its surface with sugar, which hides its
proteins from
antibodies.
Back to basics
When all of this became clear in the 1990s, scientists
went back to basics.
How is it, they asked, that people often live with HIV
for eight or 10 years
before falling sick with AIDS? And why do some never
seem to become ill at
all?
The answer turns out to be killer cells, another line
of defense against
germs. Unlike antibodies, which guard against free-floating
microbes, killer
cells recognize infected cells and destroy them.
HIV's favorite target is a blood cell called the
helper cell. This
complicates matters enormously, since one of the
helper cells' most
important jobs is nourishing and managing killer
cells.
In the first days of an infection, HIV burrows into
helper cells by the
billions, taking over their machinery, forcing them to
build new copies of
the virus and obliterating them in the process.
Eventually, though, killer cells awaken and destroy
most of the infected
cells before they can release more virus. Virus levels
fall and then level
off.
In the years that follow, the war is nearly a
stalemate. The body produces
new helper cells almost as quickly as the virus ruins
them. But their levels
gradually slide too far. At this point, virus-killing
drugs can restore the
balance, but otherwise the result is AIDS and death.
New vaccines are designed to start the opening
counterattack by killer cells
more quickly, so fewer helper cells become infected,
and the virus
eventually plateaus at a much lower level.
"By doing relatively subtle things during the
first hours to weeks of
infection, we think we can have a dramatic payoff in
allowing the body's own
immune response over the long haul to contain this
viral infection," Letvin
said.
Instead of dying from AIDS, vaccinated people who
become infected might live
with the virus for decades or even a lifetime.
Details of the vaccines developed by Yerkes, Harvard
and Merck differ, but
all involve the same strategy: First come injections
of several HIV genes,
which are taken in by muscle cells that use them as
blueprints to make viral
proteins. Next comes an immune-system booster, such as
a smallpox virus that
has been rebuilt to carry some of the HIV genes. The
ultimate goal is still
a vaccine that will block HIV infection. Experts think
a vaccine is the only
thing that will tame an epidemic that has killed 20
million people and
infects 15,000 more daily.
While much of the attention is on novel strategies, a
more traditional
vaccine is in final-stage testing. The AIDSVax,
developed by VaxGen of
Brisbane, Calif., has been given to 7,900 volunteers
in North America,
Europe and Thailand.
The vaccine is made from the outer wrapper of the AIDS
virus and is intended
to trigger antibodies to prevent infection. Many AIDS
experts are skeptical,
because the approach has been disappointing in
monkeys, and some early
volunteers contracted HIV after being vaccinated.
Promising data
However, VaxGen's president, Donald Francis, says more
promising data from
chimp experiments suggest it has as good a chance as
any other approach.
Researchers will take their first look at the results
in November.
Next in development is a vaccine by Aventis Pasteur of
Paris. It consists of
a canarypox virus engineered to carry HIV genes,
followed by a boost with
AIDSVax. The Walter Reed Army Institute of Research
plans to start testing
on 16,000 volunteers in Thailand next summer.
Still, a few dozen healthy monkeys such as Godot do
not prove an AIDS
vaccine is on the horizon. Some in the field worry
that the wish for one has
dissolved healthy scientific skepticism.
"We tend to swing from momentous lows to
momentous highs in the AIDS field,"
said Mark Mulligan of the University of Alabama at
Birmingham. "We may be in
an Alan Greenspan time of irrational exuberance,
because we need this so
desperately."
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