In a global pandemic, the medical community rises up to find a cure.
With viral diseases, that cure often takes the form of a vaccine. But with the human immunodeficiency virus (HIV), the quest for such a vaccine has been a 30-year journey.
However, the end of the quest may be drawing near.
A clinical trial is scheduled to begin in November in South Africa for a potential HIV vaccine. About 5,400 people in four different sites in that country will be involved in the trial.
A smaller trial with 250 participants took place in South Africa in 2015. The successful results of that trial were presented in July at the 21st International AIDS Conference.
As this particular vaccine goes through the scientific process, some may wonder why it has taken more than 30 years to get this far.
Three decades of research
In a report published in 2015 in the journal Science, researchers from the National Institute of Allergy and Infectious Diseases (NIAID) took a look back at the past three decades of research and action into an HIV vaccine.
Although the acquired immune deficiency syndrome (AIDS) epidemic is often associated with the 1980s and early 1990s, AIDS and HIV are still very much a part of many lives in the United States and around the world.
A vaccine against HIV would help millions.
“Obviously, a vaccine for HIV is one of the most important goals that we have if we want to durably end the AIDS epidemic,” said report co-author Dr. Anthony Fauci, director of NIAID. “I think we’re doing a very good job of decreasing death and infections, even in the absence of a vaccine.”
About 1.2 million Americans over the age of 13 were living with HIV at the end of 2012, the most recent year the Centers for Disease Control and Prevention (CDC) has data for. Across the world, there are an estimated 37 million people living with HIV.
Of those living with HIV in the United States, nearly 13 percent did not know they were infected. Each year, approximately 50,000 Americans are newly infected with HIV. For those people, a vaccine could mean never developing AIDS.
“A vaccine, as with all viral diseases, will really be the nail in the coffin for HIV,” Fauci said.
The medical and research community isn’t there yet, but it’s getting close, he added.
The research road
AIDS entered the U.S. consciousness in the early 1980s.
That was about the time the CDC published a report on June 5, 1981, detailing cases of a rare lung infection in five young, previously healthy men who have sex with men, in Los Angeles, according to AIDS.gov.
A flood of similar reports inundated the CDC, as doctors across the United States noticed similarities.
What followed was an AIDs epidemic that was politically and emotionally charged.
Congress enacted the Ryan White Comprehensive AIDS Resources Emergency Act in 1990, which provided $220 million in federal funds for HIV care and treatment services in its first year, according to AIDS.gov.
Fast-forward nearly 20 years and the United Nations hosts its High-Level Meeting on HIV/AIDS in New York, recognizing milestones over the course of the 30-year pandemic.
Now, researchers have published their overview of the journey toward a vaccine for HIV.
One is an empirical approach and the other is theoretical.
The first HIV vaccine trials ran in the 1980s. Since then, a tension has existed between the desire to move quickly and the point of view that thorough research would lead to success.
But HIV itself offered its own obstacles to a quick development of a vaccine — it’s a resilient virus. Although HIV was first identified in 1983, according to the survey, there still isn’t a definitive vaccine.
The reason is that for most viruses, a vaccine that spurs a natural immune response is enough, Fauci said. That is not the case with HIV.
“There was a misconception early on in HIV vaccine development where we naively, and understandably, felt that if we had a vaccine, all you had to do was give it to a person to induce the natural response,” Fauci said. “That was before we fully appreciated how inadequate the normal response to HIV was.”
Past super viruses like smallpox were eradicated by using a relative of the virus to induce a natural response. With HIV, that’s not possible. And there is a precedent for viruses like HIV that has proven difficult to make a vaccine for.
“Probably the two other major global health threats that have been very, very difficult to get a vaccine for are malaria and tuberculosis," Fauci said.
Two potential solutions
The report outlines two promising approaches to a vaccine.
One is the empirical pox virus-vectored gp120 env prime with a protein boost that supercharges the vaccine.
The theoretical approach involves a neutralizing antibody, bNAbs.
Both are in early stages of development, but both are promising.
“There have been an incredible amount of papers published … that are really starting to open up the door and show us some of the light at the end of the tunnel,” Fauci said. “I would be foolish to predict when we would get a vaccine, but I can say with absolute certainty that what we know now compared to three years ago is an enormous difference.”
Editor’s Note: This story was originally published on July 24, 2015 and was updated on September 21, 2016.