Promising HIV vaccine passes phase one human trials with 90% success rate | Hacker News Reader

Promising HIV vaccine passes phase one human trials with 90% success rate

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316 pointsgrannyg00se97 comments

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...

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.

And with any luck by that time everyone who has it but refuses to seek treatment will be dead, and everyone else will have been exposed to years of news about the vaccine.. and years of people refusing to take it dying.

I think things should work out well in the end, but it might take a while.

"Refuses to seek treatment" is not necessarily a fair description of these people's actions. They can get HIV at birth through their mother without engaging in any "at risk" behavior. They can have it and not know it. They can lack education. They can lack resources. They can have received misinformation.

There are places where the official government-endorsed treatment for HIV was sex with a virgin. There are religious notions that declare use of birth control sinful. There are moral police that call education about safe sex (instead of abstinence) wrong, despite its proven efficacy.

The tough part about vaccines is that they only protect the recipient from the disease if they get the vaccine, and they only eradicate the virus if everyone on the planet is vaccinated. The Science (making the vaccine) and cost (creating enough vaccine) are only two barriers. Getting everyone (and it really must be EVERYONE) to take the vaccine is a very challenging project. That's what makes the story of [edit: smallpox] so fascinating.

Here's a relevant TED Talk about pandemics: http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...

You don't need to get 100% vaccination to eliminate the disease; somewhere around 90% works, unless it's incredibly contagious and in a high density environment.

"Herd immunity" protects the others -- basically, the disease itself can't spread if a sufficient number of people are vaccinated, so it dies out in a few generations (of the disease, not of humans).

From my classes in veterinary medicine, I believe the herd immunity is around the 80% mark, at least for livestock and their diseases.

It depends on a lot of factors -- how many people will catch the disease, assuming no one is vaccinated, per infected individual is the primary one). I think most livestock diseases are aerosols (foot and mouth disease, etc.), and so are a lot of human diseases, but thankfully not AIDS.

The problem is the standard models of herd immunity depend on some simplifying assumptions which may be true in livestock, but are not true in humans -- specifically, that it's a homogenous population with equal chance of giving any other individual the disease, and that vaccines will be distributed fairly randomly as well.

If you have backwater villages which never get vaccinated, and are highly interconnected, you can end up with persistent reservoirs of disease, even if it's only 1% of your overall population. Then, you can have periodic epidemics when an individual from that area travels to an unvaccinated area elsewhere (because compliance rates on vaccination go down once the disease is "cured" in a population).

(I know about this from drinking with some of the UN/WHO vaccination people in Afghanistan)

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.

I think his point is that much of the problem of preventing the spread of HIV has less to do with the science of killing the virus, and more to do with the difficulty of actually getting it in the hands of people who need it. There are already very cheap, readily-available ways of preventing HIV transmission (condom use comes to mind), but people aren't using those. The reasons are varied, but some cite misinformation, cultural misconceptions, government ineptitude, and so on. Even if there were a 99% effective HIV vaccine that were as cheap as water, it still wouldn't make it into the hands of every person in the developing world. Proof of that is the fact that we can't even get water to all of these people.

Proof of that is the fact that we can't even get water to all of these people.

Not sure how good an analogy this is. I suspect it would be moderately expensive (i.e. on the order of a few billion dollars), but possible to deliver a liter of clean water to nearly everyone in the developing world. The problem is, that solves their water problem for about 12 hours, if you're being generous. Solving their problem long term is the hard part. With vaccines, you only need to visit the people a finite number of times, and then you're done. Given that HIV is sexually transmitted (and assuming that the vaccine can be given relatively young), you wouldn't even need especially frequent visits to immunize the next generation of people.

In the context of this discussion, I believe "a few billion dollars" would be pretty cheap.

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."

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.

I'm confused by the statement that a vaccine would not be a game changer in terms of worldwide infection. Right now, the only way to reliably prevent HIV infection is through changing behavior, which is extremely difficult. But widespread use of a vaccine would just require a one-time injection, which is relatively easier.

I'm further confused by your polio reference, because that sort of effort would only be possible with a vaccine.

Not to be pedantic, but is it the case this would only be a single injection? I believe that some vaccines can need repeat/regular treatments over a (relatively short I think) period of time.

If that were the case here it would make vaccination much harder, though still possible of course.

That's a fair point, but I still think that's an order of magnitude easier than changing life-long behavior regarding sex partners.

EDIT: I actually meant smallpox when I was talking about polio. That's a big error; corrected it above. Thanks rdl.

I should have been more specific - I meant that if we did develop a vaccine, then it makes following the [smallpox] example theoretically possible, but this is still extremely challenging due to the reasons given.

Although you and I might have the vaccine, not everyone has it - not by a long shot - because not everyone is born in a modern westernized hospital. These people are protected by virtue of an extreme mobilization to literally isolate every single instance of the virus. It (hopefully) only exists in the lab at this point.

You may be thinking of smallpox, which exists in one or two declared labs (and probably a few more black labs).

Polio is unfortunately still "in the wild" in certain areas (Afghanistan/Pakistan/India, Sub-Saharan Africa), and had a bit of a resurgence lately. The Gates Foundation is putting a lot of effort into finishing up polio eradication.

Relevant TED talk: http://www.ted.com/talks/bruce_aylward_how_we_ll_stop_polio....

One of the main issues is that the polio vaccine requires a cold chain (presently; I think they have a new shelf-stable one); the smallpox vaccine, at least one of them, does not.

FYI, there has been only 1 reported case of Polio in India this year (since January). It might be that time when Polio is finally eradicated from India

http://arstechnica.com/science/news/2011/09/polio-in-india-g...

And there have been dozens of cases of wild polio in China and the Philippines this year, and a current outbreak of 84 cases in Pakistan, according to the WHO. http://www.who.int/csr/don/en/index.html

I agree with that. Thanks for clarifying.

Not everyone needs to be vaccinated for the phenomenon of 'herd immunity' to kick in:

http://en.wikipedia.org/wiki/Herd_immunity

Actually, circumcision is a proven way to reduce infection rates that doesn't involve behavior. Though, as one might imagine, it can be a tough sell in cultures where that isn't the norm.

Just because infection rates are lower among males who are circumcised doesn't mean it prevents infection. http://en.wikipedia.org/wiki/Correlation_does_not_imply_caus...

Neat.

Except there have been dozens of randomized, controlled studies that show circumcision significantly reduces risk of infection.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

http://www.sciencedirect.com/science/article/pii/S0140673607...

http://www.sciencedaily.com/releases/2006/12/061213174708.ht...

http://journals.lww.com/aidsonline/Abstract/2000/10200/Male_...

Only amongst people who don't use condoms.

This guy presents a fair scientific examination of whether to circumcise: http://www.youtube.com/watch?v=i2gloq-prkA

Then why does the USA have the highest rate of circumcision and also the highest rate of HIV infection of developed countries? I don't think the claim holds up under scrutiny here.

[EDIT: wording]

Actually, this is a reasonable observation. But it actually does make sense.

My understanding is that many (all?) of these studies have been conducted in sub-Saharan africa. The environment in which AIDS spreads may be very different in developed countries. The presence of secondary infections, unhygienic conditions, and other social norms may play a big role in the spread of aids and greatly amplify the protection that circumcision provides. The evidence does look compelling.

Now, if the infection rate is already low, secondary STDs are rare, hygiene is at a very high standard, and transmission vectors are different, then the effects might be much less pronounced. I suspect it would be hard to create a controlled study of this in Europe, since you'd have to convince a large number of men who are probably in a very low risk group to be circumcised.

Thank you for expanding on my admittedly rushed comment. I agree that comparing health data in the US to that of developing countries is problematic. But it raises interesting questions.

One question, that I don't think has been answered sufficiently is that the controlled trials and published studies have been criticized for possibly overstating the effectiveness of treatment. (The trials were stopped early on ethical grounds which can overestimate the effects being tested.) Wikipedia has a fairly comprehensive roundup: http://en.wikipedia.org/wiki/Circumcision_and_HIV#Randomised...

I think my bigger point, though, is that it's easy to look at data and say, "Aha! This one thing is the solution" without stepping back and looking at all the different pieces that make up the big picture. It's going to take some combination of education, prevention, vaccination, and health policy to tackle this disease.

You don't think which claim holds up? That circumcision cuts infection rates? As I posted in a comment below, there's a fair bit of scientific evidence to support that.

The US has a wide range of ethnic, cultural, and socio-economic diversity that throws off a lot of statistics when compared to other, relatively homogenous developed countries.

Circumcision has well known downsides, and its effectiveness is limited (~50%) so people would still need to wear condoms to be reasonably safe.

Of course you should use condoms, not share needles, and get tested regularly.

But a 50% decrease in new HIV infections is huge!

It can be a tough sell because it's almost always forced genital mutilation carried out on defenceless infants violating their human rights and causing irreversible damage or done by pressuring men into it without telling them the downsides.

"those infected with HIV - who get treatment and adhere to that treatment - can live long and relatively normal lives."

The adherence part is the most interest bit of the story. The adherence to HIV medications is ~93%, much greater than the adherence to almost every other drug or behavioral treatment. If diabetes patients or cardiac patients had adherence rates anywhere near that high then the life expectancy of the average American would be dramatically higher.

Do you know why they reach +93%?

There are lots of different variables that influence adherence, including but not limited to:

- expected or actual efficacy

- regimen complexity

- knowledge, commitment, and ability

- doctor-patient relationship

My understanding is that with HIV a lot of money has been spent on actually implementing the adherence research in order to reduce the spread of the disease, whereas for most other diseases no one really cares. I think getting diagnosed with HIV also encourages some people to grow up a little bit in a way that getting diagnosed with high blood pressure or whatever doesn't, though maybe less so now that infection vectors are changing.

It might also be worth noting that adherence with HIV medication is also motivated by simple fear: if you don't take it, you will die. Painfully, from secondary infection.

Diabetes (type 2) and cardiac disease are scenarios where people can still kid themselves to a certain extent.

"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."

Except the side effects (as with any drug therapy) can be severe. And the effects of long term use is anybody guess. Many patients who lived, just now reaching their 50's; are experiencing everything from diabetes to chronic kidney and liver disease to macula edema.

Course the trade off is death. So maybe it is a good deal.

Just to confirm this, at work (http://github.com/praekelt & http://praekeltfoundation.org) this exactly the problem we are up against in Africa.

There's an important difference between HIV and smallpox. To eradicate smallpox, it suffices to vaccinate all the humans. But to eradicate HIV, you have to vaccinate all the apes. This family of viruses has already jumped species twice, so no doubt it will do so again.

Aren't infections more likely to go up if people can survive HIV with medication indefinitely. More survivors means more people who can infect other people?

Quick question: I thought that vaccines were supposed to be a problem for HIV. They trigger the immune system response which quite literally forces the food of the HIV virus to come to it faster. Vaccines were supposed to speed up the rate of infection. That was supposed to be the paradox of HIV. So question is, is this vaccine really news or just another one of these? Sorry I am not that well versed in this sort of topic.

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.

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.

"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.

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

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)

Yes, but those cases are much, much less worrisome than AIDs in its current state.

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.

Sorry to hear that about your mother. I hope everything turned out okay.

Yeah she made a remarkable recovery - she was left with a very slight scar on her forehead. However, she was still bothered by pain from the afflicted area for years after.

I had it when I was younger, and I heard it only gets worse if you get it when you're older. It was pain unlike anything I've experienced since, I can't imagine what it felt like for her.

I had it under my ear when I was young. I don't remember how painful it was and it healed perfectly (ie no scars or anything). I guess I probably only had a mild case.

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!

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.

Varicella pneumonia? Encephalitis? The virus that causes chicken pox is not harmless.

It's not harmless and there is a varicella vaccine now. (There wasn't when I was a kid.)

Pretty sure they're talking about the still annoying but no death part.

Around 1 in 4 or 5 women in the UK have herpes. I think the stats are similar for the US. It's still a problem, but most people suffer little from having it. It still has a stigma attached to it, hence why people don't admit to it, which makes me think the comparison with HIV is a fairly good comparison.

I'm pretty sure the author meant hepatitis, which is much more similar to HIV in many regards, and now effectively “solved”, although the global vaccination program is still underway.

Ask anyone who has HIV whether they'd trade it for herpes.

That's not the comparison being made. It's not HIV vs herpes - it's HIV with a highly successful vaccine available vs herpes, which has no vaccine.

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.

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.

Yes, that is the point - somewhat ironically missed by the "easy to miss" comment's owner.

Ha, oops. I don't know how I managed to mix up vaccine and cure - my brain must be asleep. Thanks for pointing it out.

No worries. I get mixed up every day.

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.

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... (Spanish)

Correct. Phase 1 is where they check to see if the vaccine is safe. Considering the history of HIV Vaccines, it's way too early to get excited.

As others have pointed out, a the point of a "phase 1 trial" is to find out how safe the treatment is. This drug passed.

Once that is done, how well it works is the Phase 2. See here: http://en.wikipedia.org/wiki/Clinical_trial#Phases

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.

Here's a short presentation on clinical trial success rates: http://insidebioia.files.wordpress.com/2011/02/bio-ceo-biome...

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

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.

It says they used 30 people.

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.

In this case, they seem to be testing the blood for markers that should indicate an ability to repulse an HIV infection. Not the most scientifically informative experiment one can imagine, but also pretty straightforward ethically.

Actually, since HIV infects the blood (white blood cells, specifically), it's a rather accurate measure of its effectiveness.

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

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.

[citation needed]

First I've ever heard of anything like this.

I've heard it before... unfortunately. It is well within "nutjob territory".

It's a fair statement to say that no credible scientist in the field honestly believes this.

I heard about this when reading the (non-peer reviewed) journal Medical Hypotheses

http://hivskeptic.wordpress.com/2009/07/12/official-italian-...

However, the article was withdrawn by Medical Hypotheses later

http://scienceblogs.com/insolence/2009/09/pity_poor_peter_du...

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

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.

Unfortunately this idea seems more widespread than most people think. I know of 2 documentaries promoting this idea [1], and it still has it's followers. Of these, the scariest is probably the former president of South Africa [2].

Of all the pseudoscience and conspiracy theories in the world, I think this one bugs me the most, primarily because it has a real cost in human lives [3] (unlike moon landing or JFK conspiracies). Hopefully if/when a reliable vaccine is found, HIV can be wiped out for good and this will no longer be an issue.

[1] http://en.wikipedia.org/wiki/House_of_Numbers

http://en.wikipedia.org/wiki/The_Other_Side_of_AIDS

[2] http://en.wikipedia.org/wiki/Thabo_Mbeki#AIDS

[3] http://en.wikipedia.org/wiki/Christine_Maggiore#Eliza_Jane

What the fuck?

Are these the same scientists who don't believe in global warming?

I'm not sure about global warming, but last time I read about this there was an overlap between HIV->AIDS "deniers" and Holocaust "deniers".

Then again, Michelle Bachmann can speak in a public forum and decry an HPV vaccine as "slut juice" and the next day cite revoked not-even-psuedo science as vaccines causing mental retardation, so I think there's something to be said for some scientific opinions or observations being more sound than others.

(ie: the ones that actually employ the scientific method with some genuine modicum of effort.

(sorry, this is totally inappropriate), but "el-oh-el" at people downvoting this. Are you in support of blatant lies and pseudo science or holocaust denying aids denying scientists?)

This claim is made by a discredited minority. 'Many' is quite the overstatement.

This is both scientifically inaccurate and potentially murderous. Rejecting science when it comes to things like evolution is an annoying tic, but whatever. What you're saying, though, is a stance that's literally killing millions of people in Africa.

Before you say these things lightly, think about it for a few minutes.

Two answers to your post:

i) Here is a recent analysis of existing evidence: http://hivskeptic.wordpress.com/2008/01/15/hiv-has-never-bee....

ii) A prize of $100.000 "was officially offered to anybody who would demonstrate HIV particles in the blood of allegedly high viral load patients". It has not been claimed yet.

So far, there is ground for a reasonable scientific doubt regarding claiming that HIV causes AIDS. The accumulated evidence is not conclusive unfortunately.

The accumulated evidence is not conclusive unfortunately.

Kind of funny that people with AIDS tend to, you know, live, when HIV-targeting drugs are administered.

Just one of those weird coincidences, I guess.

I'm not convinced that there is much reason to doubt the HIV-causation of AIDS, I'm a bit put off about the way a dissenter is dealt with here.

"What you're saying, though, is a stance that's literally killing millions of people in Africa. Before you say these things lightly, think about it for a few minutes."

"This claim is made by a discredited minority."

I don't think there is anything wrong with not believing, but rather questioning and examining a scientific assumption. Also when it is held by the majority.

And to attack people directly, making them look stupid, evil or irresponsible is certainly no going to convince them.

I found this text [1] which encourages to question orthodoxy, but also shows very clearly why in the case of AIDS/HIV there is overwhelming evidence for causation. It makes clear note that there is not a proof.

1 http://www.avert.org/hiv-causes-aids.htm

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