Big AIDS Parley Tries To Get Past Setbacks
By Marilyn Chase (Wall Street Journal) 2 August 2008: American scientists gathering for the 17th International AIDS Conference say vaccines remain an important area of study in attacking the disease, despite recent setbacks, and they are also excited by other potential preventive steps such as a daily dose of antiviral drugs.
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American scientists gathering for the 17th International AIDS
Conference say vaccines remain an important area of study in attacking
the disease, despite recent setbacks, and they are also excited by
other potential preventive steps such as a daily dose of antiviral
drugs.
The past two years have featured frustrations on several fronts in the
battle to contain HIV, the virus that causes AIDS, with researchers
coming up empty on tests of vaccines, microbicide gels, diaphragms and
a herpes treatment. This has spurred them to refocus on some basic
questions: What makes an effective immune defense against AIDS, and how
can scientists create neutralizing antibodies that can block HIV from
infecting people?
AIDS, which exploded in 1981 as a sexually transmitted and blood-borne
disease, has killed an estimated 25 million people, and 33 million
world-wide are currently infected with HIV.
Treatment programs now reach three million people, prolonging lives,
lowering virus levels in blood and reducing transmission. But despite
efforts to block the epidemic by promoting abstinence, monogamy, condom
use and circumcision, there are still 2.7 million new HIV infections a
year -- about 7,400 a day.
In interviews ahead of the conference, which starts in Mexico City on
Sunday, researchers and donors said fresh ideas to reverse this trend
abound. Among the approaches drawing the most interest are the antibody
work of Scripps Institute's Dennis Burton; investigations by Harvard
University's Bruce Walker into "elite controllers" whose bodies
naturally keep HIV in check; and studies by Harvard researcher Dan
Barouch of "designer" adenoviruses that could power a vaccine without
the problems that doomed Merck & Co.'s experimental vaccine last
fall.
"Anybody who sees this as the end of vaccine trials doesn't understand
what's going on," said Anthony S. Fauci, director of the National
Institute of Allergy and Infectious Diseases, a unit of the National
Institutes of Health in Bethesda, Md.
In Seattle, the Bill and Melinda Gates Foundation recently boosted its
already formidable investment in HIV prevention to a total of $1.49
billion. The war chest is divided between research on new prevention
tools -- vaccines, microbicide gels, pills -- and expanding use of
existing ones, such as condoms.
Near-term excitement is focused on testing whether a daily dose of AIDS
antiviral drugs can prevent HIV infection. Known as "pre-exposure
prophylaxis," or PREP, the concept is being tested in about 20,000
volunteers around the world.
"If you ask me what will come first," Mr. Gates said in an interview,
"something like PREP has a good chance of becoming available before we
have a 100%-efficacious vaccine. The challenges are a little less
daunting. If we have that tool, it could have a very big impact."
Mr. Gates recently increased to $93 million his foundation's investment
in PREP trials.
Robert S. Grant of the Gladstone Institute and the University of
California, San Francisco is using funds from the Gates foundation and
the NIH to test a daily pill of Truvada, a drug cocktail combining
Viread and Emtriva by Gilead Sciences in high-risk volunteers in
Brazil, Peru, Ecuador and the U.S. Results are scheduled for 2010, but
could come earlier.
"We have never seen in HIV an idea tested in such a large diversity of
populations," Dr. Grant said in an interview from Rio de Janeiro.
Zeda Rosenberg, chief executive of the Washington nonprofit,
International Partnership for Microbicides, says new-generation
products include a vaginal gel based on Gilead's tenofovir, a vaginal
ring containing dapirivine from Johnson & Johnson's Tibotec unit,
and a microbicide using Pfizer Inc. AIDS drug maraviroc.
Despite widespread disillusion, Ms. Rosenberg said the success of a
microbicide is simply "an engineering problem, getting the right drug
to the right place at the right time."

