Oral Abstract Session 01 - Global HIV Vaccine Enterprise

Plenary Session 01: HIV Vaccines in the Broader HIV Prevention Landscape
PL01.01
An HIV Vaccine: A Critical Component of a
Comprehensive HIV Prevention Strategy
A Fauci 1
1 National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Bethesda, MD, USA
Traditionally, preventive vaccines have been stand-alone
components of public health campaigns. Repeatedly, they have
demonstrated extraordinary value as tools to prevent infectious
diseases, stop epidemics, and save millions of lives, with rates
of effectiveness as high as 80-95 percent. With regard to HIV
infection, we are facing a relatively unique situation where this
time-honored concept of a vaccine as a stand-alone prevention
modality is unlikely. Rather, in global efforts to end the AIDS
pandemic, an HIV vaccine would be a critical component of a
comprehensive combination prevention strategy. In designing
and testing candidate HIV vaccines, we must operate within a
new paradigm that considers the additive as well as potentially
synergistic effects of delivering an effective HIV vaccine in the
context of implementing other scientifically proven HIV/AIDS
treatment and prevention interventions. These interventions
include condoms, education and counseling, and harm-reduction
programs; treating infected individuals with antiretroviral therapy
(ART) to prevent the spread of infection (treatment as prevention);
preventing mother-to-child transmission; pre-exposure
prophylaxis with oral ART or microbicides containing ART; and
medically supervised male circumcision. An HIV vaccine could
be a major factor in achieving an AIDS-free generation if added
to a toolkit of other scientifically proven interventions that when
used in combination and adhered to, could form a highly effective,
integrated HIV prevention strategy that equals or surpasses the
effectiveness of vaccines for other infectious diseases.
PL01.02
Plenary Sesions
The Current State of Microbicides as Prevention
S. Abdool Karim 1
1 Centre for the AIDS Programme of Research in South Africa,
Durban, South Africa
AIDS is particularly severe in Africa, where women bear a
disproportionate burden of the epidemic. Worldwide, just over
half of all people living with HIV are women and between 70-
90% of all HIV infections among women are due to heterosexual
intercourse. Although the majority of new HIV diagnoses in the US
are through male-to-male sexual contact, heterosexual contact
accounts for 84% of new infections among women. Despite the
greater vulnerability of women, they have few options to reduce
their risk of acquiring HIV infection and new technologies to
protect women from sexual transmission of HIV, are urgently
needed. Topical microbicides are products designed to prevent
HIV and other sexually transmitted infections. Potentially, they
can be applied vaginally or rectally to prevent HIV transmission.
Despite numerous disappointing efficacy trial results over
the past 20 years, substantial progress is now being made in
microbicide development after the release of the CAPRISA 004
trial, which provided proof-of-concept that topical antiretroviral
microbicides can prevent sexual transmission of HIV and herpes
simplex type-2 infection. Currently, research on microbicides is
dominated by antiretroviral agents. The candidate microbicide
in the most advanced stages of effectiveness testing is tenofovir
gel. In addition to the clinical trials of tenofovir, trials are also
assessing other antiretroviral drugs, dapivirine (TMC-120) and
maraviroc, formulated as a vaginal gel and a vaginal ring, and
some early human studies on Amphora gel, a barrier and vaginal
defense enhancer, and VivaGel, an entry and fusion inhibitor,
are ongoing.The development of microbicides for rectal use has
gathered momentum recently but remains several years away.
In addition to new formulations and delivery devices, future
microbicide development is likely to focus on a combination of
antiretroviral drugs and combinations of antiretroviral agents
with contraceptives.
AIDS Vaccine 2012
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PLENARY SESSIONS