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Global Health: HIV Vaccine Breakthrough?

Solo NeedleFor the first time, an experimental HIV vaccine has been shown to protect against the deadly virus, creating media buzz and giving the public health and HIV/AIDS communities hope.

The results of the largest-ever HIV vaccine trial, which was conducted in Thailand, were announced last week in a press release. Known as RV144, the study tested a combination of two older HIV vaccines on more than 16,000 Thai volunteers. The regimen was not only found to be safe, it was also 31 percent effective in preventing HIV infections. The trial was performed by the Thai Ministry of Public Health and sponsored by the U.S. Army Surgeon General.

Almost 5,500 people die due to AIDS every day and an estimated 32 million people have died from the disease since it surfaced in the early 1980s. The trial's results have been called modestly effective and a small step towards finding a safe and highly effective vaccine to help fight the disease. A post on the Asia Health Care Blog elaborates on this cautious optimism.

“Many public health experts, even ones with close links to the project, have been cautious about getting too excited about these results, particularly experts in countries where HIV/AIDS has become a pandemic, like in India. Some have called it a base hit as opposed to a home run, and everyone is saying that just because this trial may have had some success, a ‘cure’ is still many years away. In fact, experts do not even know how the vaccine mechanism works.”

Still, organizations such as UNAIDS are hailing the findings, saying it has instilled new hope in the 20-plus year search for a vaccine, which so far has seen few successes. Many bloggers, such as Brandon Lacy Campos, were also optimistic, despite recognizing the study's limitations. Blogging on My Feet Only Walk Forward, he says:

“Let the joyous news be spread the Red Ribbon Witch May One Day Be Dead!

Even though the study found that the vaccine only reduces the risk by 31% (which is way fucking better than 0%).
Even though the study was only done in Thailand with the strain of HIV most prevalent in Asia.
Even though the U.S. Army was the main funder of the vaccine trial.

I am still tickled red by this news.

Never before has any HIV vaccine been proven to be effective in preventing the spread of the infection. But some brilliant doctor in Thailand combined two previously ineffective vaccines and came up with a vaccine that, in fact, prevented, completely, HIV infection in a number of patients… So do not begrudge me my joy. I understand the limitations and boundaries of that joy, but hope breeds faith, and faith has been known to change the world if we let it.”

Beachlover, commenting on a post on Sawatdee Gay Thailand, is also not giving up hope that a vaccine may be found. He says:

“A vaccine is likely a long way off. But it may happen eventually… they've only been going for 20 years and there's plenty of vaccines, which have taken decades to research.”

Other bloggers remain less optimistic, pointing out the study's potential flaws and questioning whether the results are actually statistically significant. The vaccine was tested on HIV-negative adult men and women, half of who received the vaccine while the rest were given inactive placebo shots. Over the course of three years, 74 of 8,198 people who received placebo shots became infected with HIV compared with 51 of the 8,197 who got the vaccine. The difference was found to be statistically significant, but PinoyPoz, blogging on Back In The Closet from the Philippines, expresses skepticism over the results. He says:

“I apologize, but really, I was skeptical to begin with. I’d never read about any even minute developments towards a vaccine against HIV. It was just too out of the blue and too sudden to be a success, I thought. I know, my pessimism got ahead of me. I just needed to read all about it myself….

… With the “vaccine”, approximately 6 in every 1,000 people got infected. But even without the “vaccine”, the chances of getting infected were still small. Just 9 in every 1,000 people. The difference? For me, minute.”

Martin, blogging in the U.K. on The Lay Scientist, also expresses much skepticism. He says:

“We have a result that is barely statistically significant, using a vaccine comprised of two components previously shown not to work, a methodology heavily criticised by a galaxy of experts in a joint letter to Science, and quirks in the results which would be consistent with the vaccine not working.

I'm not going to stick my neck out and call this trial a failure, but no self-respecting skeptic can look at this results and declare them to be anything other than tenuous.”

Some bloggers speculate that regardless of whether or not the trial results are a reason to celebrate, people may use it as an excuse to stop practicing safer sex. Jimbo, blogging from Malaysia on In My Father's Footsteps, says:

“We cannot deny the possibility of a ‘rebound’ effect, in which people are lured into a false sense of security and let down their guard, like in the early days of HIV/AIDS where gay men returned to unsafe sex when AZT, the first anti-HIV medicine produced and marketed, was made available. They thought a cure for HIV has been found! In fact, Jimbo would think that it would be foolhardy to think that such a rebound effect would not occur.”

Other bloggers hope that more questions about the trial and the vaccine's true potential will be answered when the research paper is presented at the AIDS Vaccine Conference 2009. The conference will take place from October 19 to 22 in Paris, France.

Photo of Solo Needle by stevendepolo on Flickr, Creative Commons.

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