HIV Vaccines Need to Be Developed: Interview with Sam Avrett, International AIDS Vaccine Initiative

Sam Avrett is Associate Scientific Director of the International AIDS Vaccine Initiative (IAVI), a new organization encouraging the development of safe and effective vaccines for use throughout the world. Last year, Sam co-founded the AIDS Vaccine Advocacy Coalition (AVAC); he has worked with HIV prevention programs in New York City and Washington D.C., and he served with the Peace Corps in the Central African Republic.

This interview was completed before the recent report --published this week in NATURE MEDICINE -- about protecting two chimpanzees from HIV infection with a DNA vaccine.

AIDS TREATMENT NEWS: Aside from idealism or public service,why should someone who already has HIV be interested in research to develop a preventive vaccine for uninfected people?

Sam Avrett: I think that most HIV-infected people are concerned about ending this epidemic. Vaccine research is critical because a vaccine is one of the best foreseeable ways to control the AIDS epidemic, both in the U.S. and around the world. Anyone who has worked in HIV prevention knows that, while behavioral change and condoms and clean needles go a long way toward preventing HIV, staying uninfected is hard. In the United States, studies have shown that in high-risk populations, like sexually active gay men, more than two in a hundred are newly infected each year, even with the best possible counseling. Although behavior change can do a lot, it is just not realistic to expect individual behavior change, by itself, to control this epidemic.

In terms of how basic research for a vaccine might benefit both infected and uninfected people, one possible step in developing an effective AIDS vaccine may be understanding the"correlates of immunity" -- in other words, what immune responses actually protect against the virus. If we knew this, we might be able to develop immune-based therapies for those already infected.

The body already controls HIV effectively for some time after infection, usually several years or more. We might be able to maintain this response indefinitely if we knew more about how it worked and how it was lost.

ATN: What is the status of AIDS vaccine research now?

Avrett: There are about a dozen vaccines being tested in animal studies, or small human safety studies, but none have been tested for effectiveness in large clinical trials. These include "whole-killed" and "live-attenuated" vaccine designs that have worked against measles, mumps, and typhoid;"subunit" or "peptide" vaccines made from parts of HIV proteins; "recombinant vector" vaccines that use harmless viruses to "show" HIV proteins to the immune system; and DNA vaccines, which also "show" HIV proteins to elicit an immune response.

The problem is that all of this needs more research and more funding. Researchers need better starting viruses, better animal models and immune system cells that can replicate what happens in real infection, and larger studies for conclusive results with clinical, rather than laboratory, endpoints.

ATN: What funding is now available for vaccine research and development?

Avrett: It can cost about $100 million over ten years to research and develop the average vaccine. The U.S. National Institutes of Health will spend about $150 million of its nearly $1.5 billion HIV research budget next year on AIDS vaccine research, mostly in basic science and in clinical trial preparation. The Department of Defense has budgeted about $20 million for applied research on HIV vaccines. Pharmaceutical and biotechnology companies, including Merck,Pasteur-Merieux Connaught, or Chiron, might be spending a total of $20 million or more, but no one really knows.

Is this enough? There is lots of research that is not happening because of funding. The cost of treatment and care for the 900,000 people living with HIV in the United States, let alone the 40 million people living with HIV worldwide, is astronomical. Just compared to the cost of treatment and care for the people who will otherwise become infected -- more than three million new infections every year worldwide -- the benefits of a vaccine would far outweigh the costs.

ATN: Aside from advocating for more money for research, what can the community do?

Avrett: At its best, community involvement also helps researchers with informed, honest, and impartial advice. Community advocates can support funding of research, and can provide researchers with input on research priorities, research quality, feasibility of research studies, and community education needs.

ATN: What is IAVI's role in this?

Avrett: IAVI, the International AIDS Vaccine Initiative, was started last year after several international meetings of researchers, policy experts, financial experts, and membersof the HIV-affected communities identified the need for new strategies and new ways of approaching HIV vaccine development. IAVI's strategies include direct funding of others to fill important gaps in applied research and vaccine development, advocacy for international vaccine development,and collaboration with governments, funders, regulatory agencies, and private industry to encourage greater investment into HIV vaccine research and development. IAVIcan complement the efforts of the NIH, UNAIDS, pharmaceutical companies, and other organizations, to ensure the development of safe, effective HIV vaccines that can be used throughoutthe world.

ATN: How can our readers find out more and become involved?

Avrett: First, learn more about the issue. For important background information on the current state of vaccine sciences, see the IAVI REPORT, the newsletter of theInternational AIDS Vaccine Initiative. You can obtain copies from IAVI; phone 212/852-8326, fax 212/852-8279, or mail a request to IAVI, c/o The Rockefeller Foundation, 420 Fifth Avenue, New York, NY 10018, or send email to 103423.355@compuserve.com.

You could call the AIDS Vaccine Advocacy Coalition, 415/248-1330, or check the VACT UP Web site for vaccine advocates, at (website no longer available)

Also, you might be able to work with existing AIDS advocacyor service organizations to get them interested in paying attention to the need for an HIV vaccine. And it certainly would help to let your representatives in Congress hear from you, and know that you want more funding for research on HIV treatments and vaccines.

And if you live in a city with an HIV vaccine trial site [Baltimore, Birmingham, Boston, Chicago, Denver, Nashville, New York, Philadelphia, St. Louis, San Francisco, or Seattle], you can join the site's Community Advisory Board.Contact information for each city is on the VACT UP Web site, or can be obtained from IAVI at the phone, mailing address, or email above.

Note: Background on IAVI

"The International AIDS Vaccine Initiative, a not-for-profit organization, was formed in 1996 after several international consultations of researchers, policy experts, financial experts, and members of HIV-affected communities identified the need for new strategies and new ways of thinking about HIV vaccine development. IAVI's mission is to ensure development of safe, effective, preventive HIV vaccines for use throughout the world.

"IAVI strategies to achieve this mission include: 1)advocating for greater involvement of worldwide public and private sectors, 2) working with governments, funders,regulatory authorities, and private industry to create a more favorable environment for increased investment in international vaccine research and development, and 3)directly funding a highly targeted, applied research anddevelopment effort to fund others to fill gaps in existing efforts and move new vaccine products into international clinical trials. IAVI's current and future research strategies are designed to accelerate evaluation of multiple promising candidate vaccines for eventual use by populations most in need."

[From "Developing an HIV Vaccine," by Margaret Johnston,Ph.D., and Sam Avrett, M.P.H., International AIDS Vaccine Initiative, Washington, D.C.]