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At a recent forum, experts and researchers discussed what the future holds for HIV and the ongoing quest for a vaccine. Garrett Bithell reports. 
“Science has achieved great strides towards shaping a more effective response to HIV. Yet research has not succeeded in producing the hoped-for ‘magic bullets’ of either a cure or a vaccine. We need to escalate our research efforts while sustaining and expanding what we know works: good prevention and access to life-saving antiretroviral therapy and integrated care.”
So says Professor David Cooper, Director of the University of New South Wales’ National Centre in HIV Epidemiology and Clinical Research. He joined a panel of top HIV researchers last Wednesday, April 30, to address the topic ‘A Future Free of HIV’ at a forum held on campus and moderated by Justice Michael Kirby.
“The potential for a vaccine is looking pretty grim right now after the Merck vaccine was a complete failure,” Cooper tells SX. Last September, international drug company Merck halted trials of the HIV vaccine, regarded as one of the most promising, after it was judged to be ineffective.
“So really it’s back to the drawing board,” Cooper says. “The medical and scientific community is trying to work out which is the best way to go. Do we continue to invest specifically in trying to develop HIV vaccines, or do we lobby for more money for basic research on the basis that the solution might come out of a lab that’s perhaps working on another disease or another aspect of immunology and virology? That’s the current debate.
“Vaccines are traditionally the best way to handle epidemic infectious diseases, and we’ve had some very successful ones. It should be noted that many vaccines, from the discovery of the agent to a successful vaccine, has often taken 50 or 60 years. An example of that would be the hepatitis vaccine.
We’ve known about the agent for many years but it’s taken a long time to get a vaccine.
“So with HIV we’re about 25 years out, which is not very helpful but it does put it somewhat into perspective. People are very pessimistic about whether we’ll ever have a vaccine in our lifetime.”
Cooper believes that male circumcision could be the next step in the fight against HIV. Recent scientific studies suggest that male circumcision can help reduce HIV infection rates in men by 70 per cent.
The clinical reason for this preventive effect is still being investigated, but one theory is that the foreskin has a very thin lining and suffers minor abrasions during intercourse, making it easier for the HIV virus to enter a man’s bloodstream. Another is that the foreskin is rich in Langerhans cells, whose surface is configured in such a way that the AIDS virus readily latches on to them.
“In countries where there are generalised epidemics and where heterosexual men are often infected from their female partners, it’s probably a very good strategy to implement,” Cooper asserts. “And if we had a vaccine that was 70 per cent effective like circumcision, we’d be implementing it tomorrow. So it’s a bright light.”
Nevertheless, he emphasises the importance of condom use and safe sexual practices in the gay community.
“I think the gay community has been exemplary in advocating the epidemic, advocating human rights and advocating more research,” he says. “The gay community must continue doing the fantastic job they’ve done over the past 20 years – particularly advocacy for more research so we can come up with vaccine, as well as for governments to provide more money for poor countries to fight the epidemic.”
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