First AIDS Vaccine Tested Did Not Protect, But Gives Scientific Leads

AIDS TREATMENT NEWS Issue #389, March 14, 2003
John S. James

The first "phase III" trial -- one large enough to determine whether a treatment works -- of an AIDS vaccine in humans found that the vaccine (called AIDSVAX, produced by VaxGen in Brisbane, California) failed to protect people from HIV infection. But thousands of blood tests now being analyzed will likely provide important information for making better vaccines. Some of this work will be reported at the "HIV Vaccine Development: Immunological and Biological Challenges" meeting beginning March 29 in Banff, Canada.

Many scientists did not expect AIDSVAX to work, because this vaccine only produces antibodies against HIV and does not stimulate another branch of the immune system called cellular immunity. Recently, however, there has been renewed interest in antibodies -- partly because of growing knowledge about how to select the right antibodies, and also because cellular immunity alone may not prevent infection but only slow disease development. HIV vaccines might need to use both.

The VaxGen report led to controversy because of suggestions that AIDSVAX might work partially in Blacks, or Asians. In Black volunteers, only 4 of 203 who received the vaccine later became infected with HIV, compared to 9 of 111 who received the placebo; in Asians the numbers were 2 of 20 vs. 2 of 53. There is a widespread consensus that no conclusions about human effectiveness can be drawn from such small numbers -- although more research is needed to look for possible racial differences, and this work has started. (This vaccine is not relevant to Africa because it was made specifically for the clade B virus, which causes the AIDS epidemic in the U.S., Europe, and some other areas, but is not common in Africa, where AIDS is caused by clade C and other clades of HIV.)

For more information on the science and controversy around the February 24 VaxGen report, see:

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