AIDS today, gone tomorrow?

[Guest guest]

AIDS today, gone tomorrow?

Seth Berkley

Posted online: Thursday, December 13, 2007 at 0000 hrs

A vaccine that mimics and improves upon the human body's natural

resistance could be key to stopping HIV. India, as an emerging

scientific power, needs to explore this opportunity

When the organisations that most closely monitor global AIDS

statistics recently released their annual report, India was at the

centre of a major evaluation of the epidemic. Using new methods of

calculating the prevalence of HIV infection, the Joint United Nations

Programme on HIV/AIDS and the World Health Organisation lowered their

estimates of the number of people living with HIV/AIDS from 39.5 to

33.2 million. More than any other factor, a drop in the estimate of

prevalence in India by about a half, to 2.5 million people, accounted

for that decline. For years now, India has been at the heart of

deliberations about the near-term future of the AIDS epidemic. For

some time, experts feared the disease would explode across the

subcontinent as it has in Africa. The latest evidence suggests that,

thankfully, this has not occurred.

While it is good news that the potential damage wreaked by HIV may be

less than once thought, there is a danger that the downward revision

of the estimates will produce complacency or, worse, a misguided

sense that the epidemic will burn out on its own. True, the new

UNAIDS/WHO statistics suggest the number of new HIV infections peaked

in the late 1990s, but at an extraordinarily high number. Another 2.5

million people have contracted the virus this year.

Antiretroviral treatments prolong the lives of sufferers, but they

are not cures. Those in the West who go on ARV therapy on average

live 12 years longer; the minority of sufferers in developing

countries who can afford the drugs live an extra six years. In any

case, while medicine can defer the onslaught of AIDS in an

individual, it does not necessarily prevent people from becoming

infected with HIV in the first place and thus cannot eliminate the

disease from our midst. Only a preventive vaccine can accomplish

that.

Lately the field of vaccine studies was rocked by news that what was

thought by many to be a promising experimental vaccine, produced by

the US company Merck, proved non-effective and might have possibly

increased the susceptibility to HIV infection in some trial

volunteers. Merck's candidate was tested in the Americas, the

Caribbean, Australia and South Africa, but the news has

reverberations in India too. For India is not merely a victim of

AIDS. Its scientists and policy-makers have become worldwide leaders

in the search for a vaccine, a search that must not, and will not, be

halted or hindered by the faltering of one product.

Some sceptics believe it is impossible to create an effective AIDS

vaccine. But research provides a solid basis for optimism. The human

body, we have learnt, is better at fighting off HIV than was

previously known. Most people who contract HIV are able, without any

outside intervention, to suppress the virus for many years; some

suppress it indefinitely. A small number are regularly exposed to the

virus but remain uninfected.

In other words, the body manufactures its own form of partial or

complete immunity. Finding out how this works is at once a challenge

and an opportunity. When we understand the process, it may be

possible to create a vaccine that mimics and improves upon what now

appears to be a form of natural resistance.

Apart from Merck's product, there are more than 30 other experimental

candidates around the world in various stages of testing. Further

analysis of the Merck results may shed light on how best to

prioritise the development of those products. India is already

playing a role in the invaluable work of testing experimental AIDS

vaccines. The National AIDS Control Organisation (NACO) and the

Indian Council of Medical Research (ICMR) are partners with the

International AIDS Vaccine Initiative (IAVI) in two such trials, one

at the National AIDS Research Institute in Pune and another at the

Tuberculosis Research Centre in Chennai.

The failure of Merck's vaccine is likely to spur new thinking about

the best way to build an effective vaccine. Indian medicinal chemists

are already doing pioneering work in this area, via a scientific

consortium put together by IAVI and through a partnership between

IAVI and the department of biotechnology, which is part of the Union

ministry of science and technology.

Research is expensive. And vaccine research is notoriously hard to

fund. People are willing to fight for treatment of diseases they, or

their loved ones, have already contracted. Vaccines, by definition,

protect the uninfected, and are often seen by people as a more

abstract concern — until the pandemic hits them, by which time it is

too late.

Sadly, private industry has not invested much in AIDS vaccines. Given

the scientific challenges involved, surer profits are to be had

developing other products. As such, Merck deserves enormous credit

for its work in this field.

In the absence of significant private capital, and in view of the

very human tendency not to give today's attention to tomorrow's

problem, the urgent work of finding an AIDS vaccine has fallen upon a

relatively small band of scientists and activists. It is imperative

that they receive funding, support and encouragement from the world

health community, international institutions, private philanthropists

and foundations such as the Bill and Melinda Gates Foundation and,

crucially, governments.

The expectations from India are among the highest. India, as far as

AIDS is concerned, is no longer simply a vulnerable nation. It is an

emerging scientific and technological superpower on whose

contribution, intellectual and material, the world is counting.

The writer is president and chief executive officer, International

AIDS Vaccine Initiative

http://www.indianexpress.com/story/249666.html

[Guest guest]

Dear FORUM,

Read Seth Berkley's article. AIDS today, gone tomorrow?

Re: /message/8226

What a lovely PR exercise. When microbicide trials can be stopped in the country

for the lack of incidence, how can the Government and IAVI justify carrying out

these trials in India??

Ramesh Vaidya

e-mail: <dr.r.a.vaidya@...>