There is no bigger biomedical research problem today than finding an AIDS vaccine.
Every day, 15,000 people get infected by HIV, the virus that causes AIDS. All of them will eventually die. After three decades of intense research, nearly 39 million deaths around the world, there is still no hope of a vaccine.
Scientists took 105 years to make a typhoid vaccine, 89 years for a whoooping cough vaccine, 47 years for polio and 42 years for measles. But the time lag was getting remarkably shorter. It took only 16 years for a hepatitis B vaccine.
So is it just a matter of time or is HIV impossible to beat?
The Hurdles
The holy grail of AIDS prevention would be a safe vaccine that gives 100% lifelong protection against all subtypes of HIV. The first issue which scientists face is the genetic complexity of the virus itself.
There are two strains of HIV, both with three subtypes each, different continents are affected by the different subtypes. So far, scientists have identified 10 different patterns of the virus, but there could be many more. And as soon as they map the course of one virus, it evolves into something drastically different.
Even if a vaccine were available, these different forms of HIV would almost certainly allow some of the virus to “escape” from any protective immune response that the human body mounted against it after vaccination.
More than 100 million US dollars have been pumped into research and there have been at least 80 clinical trials, including the massive trial in Bangkok in 2011; though we are closer to understanding the virus, we’re nowhere close to a viable vaccine.
Another big issue is with the clinical trials itself. There are ethical concerns when people are involved for an HIV trial, given the nature of the infection. And animal trials aren’t too successful because the strain of HIV in monkeys is similar, but not identical.
Currently, 22 vaccine candidates are being tested worldwide, the good news is that all this research has resulted in more effective treatment for the disease
The Truvada Revolution: What Does it Mean
The alternative to a vaccine would be a preventive pill and now scientists in the US have found one.
Truvada is a combination drug that was developed to treat the infection but studies found that giving it to high-risk population could lower their risk of contracting HIV as much as 90%.
The feat is remarkable because this is the first time we have an approved drug by the US FDA for the prevention of HIV. It’s truly godsend. It’s the ingredient we needed from so long and did not have.
The drug is so effective that only 2 out of the 500 high-risk people taking part in the study got infected over the year-long, study, scientists reported in the Journal of the American Medical Association. And that was also when volunteers continued to have risky, unsafe sex.
About 2 million Indians are at a high-risk for HIV and could hugely benefit from this pill. Sold under the brand name Truvada, critics have been dismissive of this medication, worrying that a fall-back option will promote unsafe sex and a rise in infections. Precisely why very few people are actually taking this drug, even most physicians aren’t aware that such a “pre-exposure prophylactic” treatment exists.
With no vaccine on the horizon, the drug Truvada could make the AIDS-free generation dream come true. The problem is the cost: a monthly course of Truvada can be upwards of Rs 5 lakhs. The world health bodies should chalk out an AIDS programme on the assumption that there will be no vaccine, to stop the spread of HIV. And then, even though the costs will be high, every dollar spent on controlling HIV will yield many times the benefit in the long run.
(At The Quint, we are answerable only to our audience. Play an active role in shaping our journalism by becoming a member. Because the truth is worth it.)