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This Month in HIV: A Podcast of Critical News in HIV
  

This Month in HIV: Top 10 HIV/AIDS Stories of the Past Year

May 2008

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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Back to the Drawing Board for HIV Vaccines

Wow. That's great. OK, on to number seven.

Number seven is a downer, and that has to do not so much with hope, but with defeat. What we're talking about here is an HIV vaccine. It's been pretty clear that condoms are great, but we're not going to be able to use condoms to get rid of this epidemic.

We're not going to have people adopt safe sex practices or do any of these other prevention things people have talked about to stop this epidemic in its tracks, except for a vaccine. There's been a lot of money put in by various private and public organizations to try to develop a vaccine.

One of the most promising vaccines was the Merck vaccine. It uses a virus called adenovirus -- which normally causes a cold -- to try and stimulate the immune system. The vaccine also contains viral proteins from the HIV virus that are dead, but that can be used to stimulate a really nice immune response against the virus such that when the person actually encounters HIV, they would already have really good immunity and could fight it off and prevent HIV infection. Well, that was the idea.

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The reality was that the data from a trial of this vaccine that was done among 3,000 people across the planet showed that the vaccine didn't work.27 Not only did the vaccine not work but, very sadly, people who had a strong immune response to the adenovirus at baseline -- meaning before they got the vaccine -- actually seemed to be more susceptible to HIV. There weren't very many infections during the study, there were about 44, but they were concentrated and more likely in the people who had this adenovirus immunity before they got the vaccine.

The bottom line is:

  1. The vaccine didn't work; it did not protect people compared to people who got placebo vaccine.
  2. In a subset of people with an immune response to the vector -- the thing that's included in the virus vaccine -- there even seemed to be a hint that these people were hyper-susceptible to HIV.

Is this the end of all HIV vaccines? Are there others in development?

This is the end for this vaccine. There are similar vaccines that are going to be tested, and I think what you'll see is wider use of these vaccines in people who do not have immunity, or an immune response, to the adenovirus vector.

I think there's going to need to be much further work. There's a strong and vocal group that feels that vaccines are nowhere near ready for testing in humans and that we really should go back to the drawing board. There are others who feel an urgent need to start clinical vaccine trials in people.

I think this, at the very least, puts a big chill on HIV vaccines in general. Many vaccine trials were either underway and had to be stopped, or were about to start and had to be stopped. We're going to have to try to understand what it is that's going to make the immune system develop a protective response against HIV.

The fact that people can get superinfected with virus (i.e., people can be HIV infected and still acquire a new strain of HIV), bodes very poorly for us being able to figure out how to trick the immune system to have a great response.

If natural infection with virus doesn't protect you, that means we have to do even better than Mother Nature and produce a super response. I think that's going to be extremely daunting and very difficult. Sadly, that's what we learned with this vaccine trial.

One interesting thing about this vaccine trial that came out recently was that, among men who were circumcised, there was much less risk of HIV infection -- such that it partially neutralized the increased risk that occurred by having that adenovirus immunity at baseline.28 I think that's really interesting, and again, shows that there is a role for circumcision in HIV prevention. It's not going to be the cure-all, it's not going to be the magic bullet, but it certainly can be very powerful.

Crystal Meth and HIV

On to number eight.

Number eight, basically, is just trying to understand where methamphetamine [meth] use fits into the HIV epidemic. We're learning and understanding that the number of people with HIV infection in our country is increasing, it's not decreasing,29,30 and that transmission of the virus among men who have sex with men also seems to be increasing. I'm interested, and I think others are also, in understanding how much meth use contributes to this.

What I wanted to highlight here was not a news story; there are people who work in big cities that have seen meth for years now. I think what we're understanding is that there's just not as much information as we need. There certainly isn't a good understanding of what the contribution of meth is to some of the statistics we're getting from the CDC and elsewhere. I think that's one thing.

The second thing is just how much meth use impacts what happens to people with HIV infection. I think meth use is probably going to be found, conclusively, to be associated with poorer outcomes. We're seeing some evidence that it could be associated with HIV drug resistance, and acquiring HIV drug resistant virus.31

We're seeing also that treatment for methamphetamine is dismal, and that the prognosis of people who are meth users is not very good.32 We see this in people; in their testimonials, they indicated that getting off this particular drug is extremely difficult.

I think that there is a story here. I think it's one that's going to persist. I think that all we need to do is not lose track of how methamphetamine is probably responsible for more than we realize when it comes to the expanding HIV epidemic here in our country.33 It's not only on the West Coast; it's not only on the East Coast; it's in the interior. I work in North Carolina, and we're seeing this in rural dwellers; we're seeing this in the Midwest. I think this is a big story, and we're only seeing the tip of the iceberg, here.

It's about the present as well as the future, then?

It totally is. The best prediction of the future can be examining the past, and we've seen what happened with crack cocaine. I think we're starting to see the signal from methamphetamine. Methamphetamine use in one of the studies that I cite from San Francisco has increased dramatically among homeless and near-homeless people -- from 5 to 15 percent.34 We're seeing the use among men who have sex with men increase dramatically.

The characteristics of this drug are like nothing we've ever seen before. People become hypersexual; people become wide awake and have sex for hours and days at a time. People are not using meth and then putting on a condom.35 It causes impotence so that some men who are normally on top become bottoms, leaving them more susceptible to HIV infection.

It's just incredibly devious and evil, and it's the kind of thing we don't need right now. I think it's erasing some of the benefits and some of the advances we had in trying to control this infection and the spread of this infection. I think this is a huge concern. Maybe I'm being Chicken Little and saying the sky is falling, but from all the data I'm seeing, I think that methamphetamine use is one of the biggest threats we're going to face in this country when it comes to containing HIV infection.

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Copyright © 2008 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


  

This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
 

Reader Comments:

Comment by: William (London, UK) Wed., Jan. 13, 2010 at 5:38 am EST
My name is williams, I am 35 years old male from London, UK.
I do not have HIV but i am very sad to learn that many people are dying of this disease. I can help or support someone who have this disease in any way that I could. I can also be your best friend or even lover.......
I am looking for good friends from all over the world. It doesnt matter if you have HIV or not.
I am a good Christian and do not care about age, race, color or religion as we are made by the same God...
I HATE Lies, injustice, terrorism and discrimination..
If you wanna be my friend send me an email with the subject: FRIENDSHIP.
Peace and Love to you all..
This is my email address: williampeaston@yahoo.com
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Comment by: Sima (Dsm) Sat., Jan. 24, 2009 at 11:00 am EST
Thanx for the wonderfull web site.i now know where to get different information about AIDS/HIV.
Reply to this comment


Comment by: Priscillar (South Africa, Johannesburg) Thu., Nov. 20, 2008 at 10:49 am EST
I was diagnosed last year, 2007, with a CD4 of 59. Now I am at 550, taking Truvada and Stoctrin. What are my chances of opportunistic diseases, and toxicities? I need to be linked with a friend in SA.
Reply to this comment


Comment by: azazhu (Ethiopia) Tue., Oct. 7, 2008 at 10:06 am EDT
that is very itnteresting
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Comment by: jim (alaska) Tue., Oct. 7, 2008 at 2:12 am EDT
i get the body regularly in e-mail and I am so thankful to all the wonderful doctors that contibute. I found out I had AIDS when I was hospitalised in 2000 with pml encephalitis and thank god for great doctors and great medicines i am alive to write this and i am am doing quite well. my past doctors whom i have kept n contact with in oregon are amazed. i was paralyzed on the right side of my body and they told my mother i would not survive the week. now i am a truck driver driving big semi's! People, get tested. If applicable, get on meds and PLEASE do not miss any doses. i say this from the bottom of my heart! You can e-mail me at willow444@msn.com. have a wonderful life! GET TESTED!!!!! Thank you again wonderful doctors!!!!!!!
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Comment by: caco (florida) Mon., Sep. 22, 2008 at 11:11 am EDT
Will we ever find a cure for HIV?
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Comment by: runing.outof.time (vaal) Wed., Sep. 10, 2008 at 7:22 am EDT
we r dieying. where or when is the cure
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Comment by: simone (Rosebud,SD) Tue., Sep. 2, 2008 at 12:42 pm EDT
I'm working to get the Native American people to get tested on the Reservation we have no testing. I'm working to collaborate with IHS to start testing I'm with the CHR Program. The hardest part is trying to get the people to get tested. I'm going to do the best I can to get them tested. I just wanted to let people know that their is a problem getting people tested everywhere.
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Comment by: lashawna Mon., Aug. 11, 2008 at 8:46 pm EDT
i think people really need to understand what sex is. too many people think it's ok to have unprotected sex when it is not ok. if you are going to do something with someone, wrap it up please. be the smarter person. that goes for straight people and gay people. get it together people! life is too short, please do not make it shorter.
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Comment by: jerry morales Thu., Jul. 31, 2008 at 1:33 pm EDT
I have a comment for dissidence 101, you weren't to concerened about vaccine success when you became infected and these drugs do seem to be keeping me alive. So bravo for the new drugs. I'm on Prezista and Isentress and celebrate their arrival. I'm sorry life doesn't seem as rosey for you.
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Comment by: Casey Fri., Jul. 18, 2008 at 12:14 pm EDT
I was wondering if you knew where to find information on how to join a certain study group of individuals with HIV+ in their states?
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Comment by: Innocent Fri., Jul. 11, 2008 at 9:10 am EDT
I have recently been diagnosed HIV+ but now i have hope that i can live longer but i've got a problem with FLU & Tonsils
help....S.A
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Comment by: Jason Mon., Jul. 7, 2008 at 7:16 pm EDT
I read that CDC predicts that if someone is positive less than four months that they can eliminate the virus from the body (with meds) within an average of 7.7 years. Is this true?
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Comment by: rami Mon., Jul. 7, 2008 at 3:28 pm EDT
Thank you very much for this energy you are putting into these podcasts / reviews. i find this so importnat. this gives much hope and info. Thank you!
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Comment by: wam Sat., Jul. 5, 2008 at 12:49 pm EDT
Hi Ezekiel Otieno where are you in Kenya. I am also positive living in U.K detected about 9 mths ago single mum of three. You can email me at nan.sa08@hotmail.com
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Comment by: Gideon Lawal Mon., Jun. 30, 2008 at 9:34 am EDT
Well am kinda new to this well. i lost my brother to this disease. right now the last time i check my status i was positive too and then my cd4 count is 375 and am still on oi. i need a friend from Europe and USA and anywhere in the world to help pass through this hard time right now am having stomach pain and headache.. here is my email: gideon080seyi@yahoo.com

Hope to hear from you soon
Later
Seyi
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Comment by: mickery Sun., Jun. 29, 2008 at 2:06 pm EDT
That's a great interview that everyone (whether positive or negative) should read.
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Comment by: dorcas Thu., Jun. 26, 2008 at 8:28 am EDT
doc.a big well done 4 d enlightenment.it goes a long way to give hope and encouragement to all the infected.its a therapy.hiv is a fundamental right and not a disease that needs to be adhered to.thanks
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Comment by: abdalla Tue., Jun. 24, 2008 at 3:21 am EDT
very exciting!
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Comment by: Robert Tue., Jun. 3, 2008 at 1:42 pm EDT
Dear Drs. at "The Body"

Keep up the good work! As you say all the time, there are great drugs out there but prevention is key!

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Comment by: bruno Sun., Jun. 1, 2008 at 8:40 pm EDT
god bless us all. stay strong people.
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Comment by: jason Sat., May. 31, 2008 at 10:33 am EDT
are there some of those drugs here in the philippines and how much its cost?
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Comment by: hilary Wed., May. 28, 2008 at 6:30 pm EDT
i have just found out my wonderfull nephew is HIV. Am so upset, my world has came crashing down. Thank God i can read positive stories. i can only pray he will outlive me. This happens to other familes not mine or so i thought. feel so ashamed. i thought HIV was AIDS I'm learning, however we all pretend it is not happening. i pray for a cure.
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Comment by: araceli villafania Tue., May. 27, 2008 at 2:07 pm EDT
very good info
Reply to this comment


Comment by: TEDDY Thu., May. 15, 2008 at 9:05 pm EDT
Good job, but we need drugs that you could take once a month,any possibility? I know the pharmaceutical companies will frown over this as it will make volumes on profitable
Reply to this comment


Comment by: johnk Wed., May. 14, 2008 at 12:55 am EDT
What a smart, sharp overview! I too think the plethora of new interesting drugs is the story of the year. They have given me lots of hope as I've undetectable for the first time in 15 years! HIV medicine has made such strides. I'm one lucky man!
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Comment by: John morse Sun., May. 11, 2008 at 10:42 pm EDT
I was diagnosed with HiV at age 70! I am currently enrolled in a trail 96 week study for HIV naieve people. I am taking MK-0518 (or Placebo) Efavirenz (or placebo) and Truvada. within three months of taking the medications My viral load was undetectable and CD was up to 415 from 275! I have been on this program for a year now.
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Comment by: dissidence101 Sun., May. 11, 2008 at 10:22 pm EDT
That's just simply amazing that the biggest story of the whole year is "THERE'S MORE DRUGS". Gezze. I have a better one. How about and to the dismay of researchers, Merck's v520 complete and utter vaccine trial failure?
Reply to this comment


Comment by: Noni Sat., May. 10, 2008 at 3:20 pm EDT
I started treatment in 2003 with CD4 of 8.I was on d4t, 3tc. I experienced loss of fats in hips and butt and changed to azt. Problem is i always worry about what if it doesnt work because in S.A we have only limited (2) regimens available. Are we S.A allowed to have or access these plenty of meds available in U.S.A and other countries? If so how do you access them?

Worried in South Africa
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Comment by: ezekiel otieno Sat., May. 10, 2008 at 9:10 am EDT
this website has given me a lot of strength.Through this I've learnt that i can live long enough than the seven years since i knew my status and i'm not alone.
I'm requesting this website to connect me one person living positively in Europe or Asia. I am from Kenya.
Reply to this comment


Comment by: Carole Ricks Wed., May. 7, 2008 at 7:45 pm EDT
Hello Everyone;

I would like to say how happy I am for all that have found their meds to work and they are doing great, Thank God for that, because He is always looking out for us all the time. I lost my brother to Hiv/Aids last year because he didn't and wouldn't seek treatment until it was too late. I miss him very much and I also have another brother who is Hiv positive as well. He is keeping up with his doctor's visits and taking care of himself. Please know that there are programs out there that can help you if you are sick. Don't wait! Seek help right away and remember that knowledge is power. God bless you all.
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Comment by: Dr. Elizabeth Mwanukuzi Wed., May. 7, 2008 at 10:20 am EDT
It is very interesting to note that the problem of late diagnosis is not limited to resource poor countries but what is particularly challenging to us in Africa is the poor accessibility of care and treatment facilities for rural communities because of poverty and poor travel intfrastructure
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Comment by: A AL YAZOURY Wed., May. 7, 2008 at 10:02 am EDT
THANK U GUYS FOR THIS GEART WEBSITE,THANK U VERY MUCH DOC FOR YOUR GREAT EFFORTS, I SUGGEST HIV TESTING FOR EVERY PERSON ONCE THEY ARE IN THE PROCESS OF GETTING ENSURACE CARD SO THIS WILL MAKE IT MORE EASY FOR EARLY DETECTION FOR THE VIRUS AND EARLY HELP AND BETEER PROGNOSIS, GOD BLESS U ALL.
Reply to this comment


Comment by: Akan Ituk Wed., May. 7, 2008 at 9:33 am EDT
A major problem with the HIV pandemic is that most folks is yet to come in terms with the reality. They "believe" they are uninfectable and as such need not to go for HIV screening. It is not until HIV is succesfully demystified, social immunization will not be achieved.
Reply to this comment


Comment by: AMAL Wed., May. 7, 2008 at 7:46 am EDT
THANKS DOC FOR YOUR WORK, PRAYERS FROM THE HEART FOR ALL THE POZs TO GET WELL SOON. IT'S A MATTER OF TIME, ONCE YOU R IN THE ACCEPTANCE STAGE YOU CAN LIVE NORMALLY. THANKS
Reply to this comment


Comment by: Brown Family Foundation Tue., May. 6, 2008 at 9:26 pm EDT
This article was very informative. Our organization promotes HIV Prevention and Detection. We've established a program called "Sisters Can We Talk". This program consist of panel discussions and small group sessions dealing with the subject of HIV and AIDS. We utilize local organizations to provide testing at each event.

This confirms that more opportunities are needed to present testing.
Reply to this comment


Comment by: Stuart Lee Carlson Tue., May. 6, 2008 at 5:46 pm EDT
Doc, thanks for your good work!

I've been poz for over 18 years now, and can say with confidence the hiv bug is a manageable disease.

Reason for writing is this: Fat has been stripped from my arms, legs, and butt. If it would help, I am quite able to give you the litany of all the drug regimens between start to the present. In summary first drug was AZT in 1992, when CD4 was 290. Currently I am taking Isentress, Aprivus, Norvir, and Epzicom and my CD4 is 770, wowee ! and VL is und.

For all I know, it seems to be a metabolic puzzle, and fortunately, no facial wasting, thank God.

Please advise.

Cheers!
Lee
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