

Promising HIV vaccine passes phase one human trials with 90% success rate - grannyg00se
http://www.gizmag.com/spanish-hiv-vaccine-90-percent-immune-response/19973/

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joshklein
My father is an infectious disease specialist who has spent the last 30 or so
years working on HIV in research, patient treatment, and education. The
following thought comes from my casual conversations with him, and probably
does not represent his professional opinion. It certainly does not reflect his
specific thoughts in regards to this trial, as we haven't yet discussed it.

The progress in treating HIV since it first entered the popular psyche has
been significant. It is no longer a death sentence in the developed world, and
those infected with HIV - who get treatment and adhere to that treatment - can
live long and relatively normal lives.

The real problem is in the developing world, and amongst populations in the
developed world that cannot or will not seek/adhere to treatment. Treatment is
sufficiently advanced that, while further developments of a vaccine are
unbelievably exciting, they are not necessarily a game-changer in terms of
worldwide infection. We have a long way to go in terms of beating this virus.
Theoretically, we could follow the same route as with [edit: smallpox],
unifying and mobilizing the world to isolate and then eradicate pockets of the
disease, but this is a much larger effort than the one taking place in the
lab, and is a question of government & administration, rather than medicine.

Edit: Bringing it up from a comment I made below, here is a relevant TED Talk
on stopping pandemics:
[http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...](http://www.ted.com/talks/larry_brilliant_wants_to_stop_pandemics.html)

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gst
Shouldn't this be more of a temporary problem? As soon as there is a vaccine
its patents will expire at least 20 years afterwards. And then lots of much
cheaper vaccines will flood the market.

~~~
rdl
Patents aren't the problem here, but it's an interesting thought experiment to
think about what commercial terms a vaccine for AIDS or other diseases which
at this point mainly affect poor, third-world people would be distributed
under.

India would probably just violate the patent, claiming national security
reasons, and sell it for ~production cost throughout the world. The USA might
enforce a patent domestically, and it would be a rational economic choice for
insurers to pay for it for many patients instead of long-term treatment if
someone contracts AIDS otherwise -- if you have a 0.1% risk of contracting
AIDS in a lifetime, and lifetime treatment costs $1mm, it's worthwhile to pay
$100-$1000 for it.

A charity (or government) might pay for full rights to the vaccine globally,
and then distribute it for the good of humanity (and to burnish their
reputation), but the really out of the box thing would be for a consumer
product company to distribute the vaccine cheaply, purely as a form of PR.
Imagine: "Coca-Cola, the drink that is good for you. Remember, we cured AIDS."

~~~
nihilocrat
Insurance would not be quite as clear-cut, but I suppose it would be a
sensible option. Companies would point to herd immunity (linked in the
comments above) to avoid paying for vaccination for 30% or so of the
population. I'm sure they have ways to put people into that 30%, and knowing
them, they will try to cheat their customers of every penny they can.

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eli
I don't want to bum anyone out, but there have been quite a few potential
vaccines that have made it through Phase 1 trials (several made it all the way
to phase 3) only to be ultimately abandoned as ineffective or unsafe.

Phase 1 is generally a small trial that is primarily designed to test the
_safety_ of the drug, not its efficacy.

~~~
tedkalaw
True. It would be interesting to see what the success rate of reported cures,
etc in the media is.

I like hearing about scientific progress like this, but worry that it will be
another "promising advancement" that we never hear about again, like a new
cure for cancer or tax cuts for the middle class.

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grannyg00se
"if this genetic cocktail passes Phase II and Phase III future clinic trials,
and makes it into production, in the future HIV could be compared to herpes
virus nowadays".

As far as I know there is no herpes vaccine and herpes stays with you for life
resulting in recurring problems. Doesn't quite sound like a very flattering
comparison to an effective vaccine solution.

~~~
shin_lao
Chickenpox is a form of herpes and we all have it. What matters is that it's
harmless.

~~~
bhickey
While it won't probably kill you, it isn't exactly harmless. It can reemerge
as shingles.

There are cases of herpes causing death. For example, in an infant infected by
his mohel, and a laboratory researcher killed after exposure to monkey feces.
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00056008.htm>)

~~~
arethuza
Shingles can be _very_ nasty - my mother had it after I had chickenpox. It was
across her face and eyes - she was hospitalised and was on morphine for the
pain.

~~~
maaku
My aunt had nearly the same thing happen to her--it left her with no visible
scars (at least none that she told me about), but blind in one eye.

The reason medical professionals recommend parents let their children catch
chickenpox is because it the symptoms get worse the older you are. In your
later years it can even be life-threatening. Never underestimate the
chickenpox!

~~~
minikomi
I got it while working as a kindergarten teacher - it was terrible. Inside of
mouth, throat.. Turns out that fever I had in 3rd grade wasn't mild chickenpox
after all! So it goes.

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sgentle
Easy to miss: "The recent human trials involved 30 healthy volunteers, where
24 were treated with MVA-B, while the other 6 were treated with a placebo,
carried out over a 48 week period."

This test was done on healthy volunteers, _not_ ones with HIV. Although it's
promising that 90% of the patients showed an immune response, we don't know
how well that immune response translates into therapeutic benefit until it's
trialled on HIV-positive patients.

~~~
palish
Isn't the point of a vaccine to prevent, not cure?

EDIT: thanks guys, but I have enough upvotes. My comment didn't add much to
HN. Wasn't actually trying to prove him wrong -- I thought I'd missed
something and was asking for clarification.

~~~
burgerbrain
That certainly is the common point, however (provided the patient is strong
enough to survive the additional initial strain) shouldn't it also kickstart
an immune response in patients who are already infected? And once that starts,
shouldn't that likely help fight the infection?

I don't know myself, I know next to nothing about medicine.

~~~
vibragiel
It might. While this trial was meant to check if this vaccine could help
prevent or restrain the infection (a prophylactic), in the same press
conference¹ where these results were presented, the authors announced they
were about to conduct a second phase I trial, this time to check for
therapeutic effects on infected individuals.

1\.
[http://www.cienciatk.csic.es/Videos/PRESENTACION+DE+LOS+RESU...](http://www.cienciatk.csic.es/Videos/PRESENTACION+DE+LOS+RESULTADOS+DE+LA+NUEVA+VACUNA+PREVENTIVA+CONTRA+EL+VIH_25822.html)
(Spanish)

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deepakINdc
Several valid points already made here:

1\. Phase 1 is for safety 2\. 30 is a small number

But the big issue here is the reason HIV and even the common cold is hard to
treat -- high turnover and high rates of mutation.

So, even if you have Ab's and/or helper T cells (cell that remember an
infection) against one or more strains of HIV, the presentation of the strain
that an individual may pick up later on in life may be different and thus
might not mount an immune response. Also of interest -- Helper T-cell sare the
primary target of HIV.

In order to really determine if or not this vaccine is effective, we will have
to observe the responses in people who have been given the vaccine and then
contracted HIV later in life. While this is promising and will add another
barrier against HIV, its unlikely to eradicate the virus.

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kingkawn
Here's a short presentation on clinical trial success rates:
[http://insidebioia.files.wordpress.com/2011/02/bio-ceo-
biome...](http://insidebioia.files.wordpress.com/2011/02/bio-ceo-
biomedtracker-bio-study-handout-final-2-15-2011.pdf)

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appendix_a
how do you sign up people to be infected with HIV?

~~~
eli
You don't. But given a large enough group of people, some will contract the
infection "organically." So some people get a vaccine and some get a placebo
and then you check back in years later and see if the vaccine group has a
lower infection rate.

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ScottMFisher
It says they used 30 people.

~~~
timr
Phase 1 trials are for safety, not efficacy -- they don't care if the
participants are infected with HIV, because they only want to make sure that
the vaccine doesn't hurt them.

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FameofLight
Finally we are in close stage to contain , one of the unknown virus in human
history.

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JVerstry
Many in the scientific community claim there is no evidence HIV is actually
causing AIDS. Hence, even if this is a successful vaccine, there is no
guarantee it will protect from AIDS.

~~~
falcolas
[citation needed]

First I've ever heard of anything like this.

~~~
davidmathers
It was a late 80's / early 90's thing:

<http://en.wikipedia.org/wiki/Duesberg_hypothesis>

<http://en.wikipedia.org/wiki/AIDS_denialism#History>

~~~
Symmetry
Well, it was a late 80s / early 90s thing among people who weren't crackpots.
As evidenced by the OP, some people are reluctant to abandon the idea even
though there is now overwhelming evidence against it.

