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What do you think guys?
Sep 20, 2003

Gentlemen,

I would be interested in your take on the following news article from today:

http://story.news.yahoo.com/news?tmpl=story&cid=570&ncid=1422&e=6&u=/nm/20030918/sc_nm/aids_vaccine_dc

Basically it was about how optimistic scientists are about the clinical trials going on around the world.

I was thinking about this and wanted to ask you some questions.

1) Is the optimism warranted (I understand if you would not be willing to answer this one)

2) I know there are trials going on in different phases - is there any real promising standouts?

3) They cited a vaccine multiple times - would this be designed to innoculate an HIV- person or would this be used on HIV+ people only?

4) how close would be a good guess to how far we are from knowing if any of these will be a magic bullet?

Thanks loads guys!!! The service you perform (as doctors and information dispensers) is nothing short of fantastic!!!

Houston

Response from Dr. Wohl

I would be interested in the opinions of my colleagues on this forum so I suggest you re-post the question to them as well.

My $0.02 is that while the world longs for an HIV vaccine, this may not really be the answer to vanquishing the epidemic. Certainly, an effective vaccine to prevent infection (which is what the article is all about) will help those with access to it. But, recall that this disease is exploding in some of the poorest places on the planet. Places with limited access to the most basic of health care let alone HIV diagnostic and therapeutic interventions.

Assuming that a very effective vaccine can be developed (a huge assumption especially as we learn that natural infection does not seem to protect against acquisition of new strains of HIV) who will pay so that prostitutes in Bangladesh will get this technologic wonder? What about injection drug users in Kazakstan? And, will a vaccine bring increases in risk behaviors and potentially increasing transmission rates if it provides anything short of absolute protection?

If we could identify and treat those with HIV infection, reducing their viral load and increasing their awareness of safer sex and drug use behaviors we can markedly reduce the number of transmissions (and help those already infected - something preventive vaccines can not). A magic bullet would be great but right this minute we have potent medications that can reduce infectiousness and save lives yet we are not getting these to the overwhelming majority of the 40 million plus persons on this globe with HIV. Why? DW



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