'Long Way To Go' in Fighting HIV/AIDS'

Despite the progress made in the fight against HIV since it was discovered
in 1983, there is "still a long way to go," Luc Montagnier, who recently
shared the 2008 Nobel Prize in medicine for his work in the discovery of
HIV, writes in a Wall Street Journal opinion piece. HIV/AIDS is "spreading
in many countries," and even "developed countries like the U.S. have many
new infections," he writes, adding, "There is also the danger of a new
epidemic caused by viral strains resistant to treatment. Moreover, despite
the effort of thousands of researchers, we still have no cure and no
vaccine."

According to Montagnier, "many potential preventive vaccines have been
experimented with" since 1985. "A few of them made it up to efficacy trials
but then failed," he writes, adding that this is "no surprise" to him for
"two main, related reasons." The first is that HIV has "evolved to present
its most variable parts to the immune system, and it hides its crucial parts
in internal pockets," he writes, adding, "Second, the variability potential
of the HIV genetic material is enormous, although its origin is not fully
understood."

This "complexity means it is very difficult to elicit an immune response
that would protect against the many different HIV variants that infect the
human population," according to Montagnier. He adds, "In addition to its
very high level of variability, HIV has evolved several other strategies to
evade the response of the immune system, making it difficult to design an
effective vaccine." However, he writes that researchers "know that
protection against HIV is possible in natural conditions" -- including in
some people who are exposed to HIV but do not contract the virus, as well as
in "some rare individuals" who contract HIV "but do not progress toward
immunodeficiency and AIDS." He adds, "It is possible that the mechanisms
that provide resistance to infection, and those that provide resistance to
disease progression, are the same. If this is the case, accines capable of
eliciting protective immunity could be first tested in HIV-infected
individuals for the capacity to delay progression to disease and reduce
viral replication."

According to Montagnier, more than 10 years ago he "proposed using
vaccination against HIV antigens not for prophylaxis but as an additional
therapy following a short antiviral treatment." The goal in this
circumstance is to make HIV-positive people's immune systems "fully
competent, after only partial restoration by an antiretroviral treatment
reducing the viral load in the blood to undetectable levels," he writes.

According to Montagnier, in "developing countries, many infected patients
refuse to be tested and are not treated because of the stigma attached to
AIDS." He writes that the "availability of treatment able to eradicate the
infection will change their attitudes," concluding that the "epidemic will
thus gradually decrease, perhaps helped by a preventive vaccine derived from
a successful therapeutic vaccine" (Montagnier, Wall Street Journal, 10/21).

Source: http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=55103