Myles Helfand
October 21, 2009

The Thai HIV Vaccine Trial: Is It a Big Deal or Not?

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If you're feeling a sense of whiplash over the recent barrage of HIV/AIDS vaccine news, you're not alone: Public reaction to the initial results of the RV144 Thai HIV vaccine trial felt like a roller coaster.

First came the over-the-top headlines hailing the results as a veritable miracle of science. Then came the over-the-top headlines calling the results into serious doubt.

Now, vaccine experts and advocates are scrambling to prevent the world from dismissing the study entirely: Seth Berkley, the head of the International AIDS Vaccine Initiative, wrote an empassioned op-ed piece in the New York Times on Oct. 18, and Raphael Dolin, M.D., a prominent infectious disease doc at Harvard Medical School and an authority on HIV, urged a rational approach to the story in an article published in the New England Journal of Medicine. (And to their credit, a smattering of more recent news coverage, including an Associated Press article and a well-written update by Donald McNeil Jr. of The New York Times, provide a pretty balanced take on what the study results mean.)

This is, admittedly, often the way of things for us humans: Major news breaks and we go nuts about it. Then we go nuts about how nuts we got about it. Then we decide everybody overreacted about everything, it wasn't that much of a story to begin with, and we forget about it and move on to the next story to go nuts about.

But before the results of this trial are dumped into the sink and drain away into the abyss of history, it's important to make sure the story leaves the proper aftertaste. What are we left with? Did all this hubbub ultimately mean anything?

To be sure, it wasn't the best idea to hold a major press conference announcing clinical trial results that only barely reached statistical significance (and even then, only in a certain type of analysis). We know how mainstream media tends to react to breaking stories with pithy headlines, and this one was destined to be blown out of proportion because of the way in which it was first announced. (The same thing happened four years ago when the U.S. was whipped to a frenzy after then-New York City health commissioner Thomas Frieden decided to publicly announce that an area man had developed a rare, rapidly progressing strain of HIV that was "difficult or impossible to treat." He ominously warned that it could potentially mark the beginning of a new HIV superstrain. Within months, the man was doing well on HIV treatment, and no sign of superstrain outbreak ever emerged. Frieden, incidentally, is now the top dog at the U.S. Centers for Disease Control and Prevention.)

But how much can you really blame these folks? It has been a bad, bad, bad run for AIDS vaccine developers. It was less than two years ago that a spate of poor study results had experts admitting that no real progress toward an HIV vaccine had been made in two decades, and left many wondering whether there was any point in continuing efforts to develop one.

For nearly three decades now, the search for a vaccine that can prevent HIV infection has been an effort largely defined (at least to the public's eye) by its failures rather than its successes. Then suddenly, for the first time ever, a huge study shines a faint ray of hope. If you've been sitting in the dark for more than 25 years waiting for some sign, any sign of light, and you finally get it, wouldn't you want to shout "Hallelujah" from the rafters?

I am by no stretch of the imagination a vaccine expert. And based on the information I've read, I'm trying to be realistic about this. Sure, odds are the "prime-boost" vaccine tested in this study is not going to be The Answer. It may even turn out to be a complete dead-end, an approach that will never confer more than a marginal protection from HIV at best, and won't even spawn new successful avenues of AIDS vaccine research.

But a large part of me can't help but take an optimistic view of this story, even if it's admittedly a little naive. That part of me thinks that maybe this vaccine somehow will turn out to be The Answer. Or that maybe something about the study, something about the findings, will set off a spark in a researcher's brain that leads him or her to discover a method of preventing HIV that does prove to be The Answer. We just don't know, and won't know for a long time to come.

But for the first time in a long time, something major has happened to give us hope that a successful AIDS vaccine is out there somewhere, just waiting to be created. And that, if nothing else, is reason enough for me to come away from this feeling a little better about where we are in HIV/AIDS than I did before.

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