Sunday Times (Johannesburg) - October 24, 2009
Claire Keeton

The full results of the controversial RV144 trial in Thailand were released at the Aids Vaccine 2009 conference in Paris this week, which was attended by about 1100 scientists.

Professor Malegapuru Makgoba, chairman of the African Aids Vaccine Programme, said: "The Thai results were the highlight. This is a turning point and the field is moving forward. The mood of the conference depended on the Thai presentation."

Dr Pontiano Kaleebu, a scientist with the Uganda Virus Research Institute, said: "The Thai trial results were good news at the conference. Next year Uganda will be starting with a new clinical trial."

The RV144 trial found the vaccine had a 31% efficacy, in the first analysis of results from 16400 volunteers.

But a second analysis - which excluded 3800 members of the trial group because, for example, they had been injected a day late - showed only a 26% efficacy.

But the Thai ministry of public health and the US army, who conducted the trial, stood by their 31% efficacy analysis, saying it was most reliable because it reflected the study design.

However, it is still unclear exactly how the vaccine protects people from HIV - and why it only protected some of those who were vaccinated.

This question seemed to overshadow the debate about RV144's statistical significance as the conference progressed.

Dr Wayne Koff, head of research at the International Aids Vaccine Initiative, said: "We will all be looking at the Thai data over the coming months to understand what's going on here."

He said: "We have tried out a number of approaches in this field that have given us leads but not what we are looking for.

"We need to evolve to more complex vaccines."

But this week progress was reported in finding the Holy Grail of an HIV vaccine: "Broadly neutralising antibodies" or nAbs, that can block HIV infection.

Makgoba said innovative methods were leading to breakthroughs in this field.

"This has been an enigma in the story of HIV immune responses: why, when people are infected, do they not generate strong neutralising antibodies?

"Now we are beginning to unravel it with new systems biology."

All the eminent scientists at the Paris conference, which ended on Thursday, emphasised the need to integrate basic science and clinical research.

Dr Alan Bernstein, the executive director of the Global HIV Vaccine Enterprise, said his organisation's first scientific strategic plan had focused on basic science, but the 2010 plan would try to integrate basic science with clinical research.

He said the field needed more exploratory trials to deepen scientists' understanding of the immune response. A logical strategy, rooted in science, was needed to test what was going on.

Monkey studies were another arena that had yielded impressive results.

Talking about the success of a cytomegalovirus-vector vaccine tested in monkeys, Koff said: "This is the first time really that a vector-based approach has exhibited this level of control (protection against the monkey version of HIV).

"This is one of the leaders of the pack and we will be advancing the concept into clinical trials as rapidly as we can."

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