Preventive HIV-1 vaccines: where are we going?

As more than 15,000 new HIV infections occur daily, mainly in developing countries, social and political will is growing to develop a safe and effective vaccine against the virus and subsequent AIDS disease. The worldwide successes in developing and disseminating vaccines against smallpox and polio raise hopes of the possibility of developing vaccines capable of blocking the transmission of HIV-1. Early attempts to develop HIV-1 vaccines, HIV-1 efficacy trials, immune correlates of protection from HIV-1, live vector-based vaccines, deoxyribonucleic acid (DNA) vaccines, and live attenuated vaccines are discussed. Enthusiasm was renewed at the recent world AIDS conference in Geneva for ongoing research towards a HIV-1 vaccine. However, the polarity of the HIV-1 epidemic, generally affecting countries which cannot afford more than basic health care, has forced the re-examination of research priorities. Many western governments have made at least a verbal commitment to increase funding for HIV-1 vaccine research. Funding agencies such as the World Bank are considering ways to fund and deliver a vaccine if and when one becomes available, and the International AIDS Vaccine Initiative in the US is increasing awareness of the urgent importance of the issue. An AIDS vaccine is still many years away.