The challenges of an HIV vaccine enterprise

Mobilization-competent Lentiviral Vector-mediated Sustained Transcriptional Modulation of HIV-1 Expression

Current anti-HIV-1 strategies reduce replication through targeting of viral proteins and RNA; meanwhile, targeting at the level of the integrated provirus has been less explored. We show here that mobilization-competent vectors containing small noncoding RNAs targeted to transcriptionally active regions of the human immunodeficiency virus type 1 (HIV-1) long terminal repeat (LTR) can take advantage of integrated virus and modulate HIV-1 replication. Transcriptional silencing of HIV-1 correlates with an increase in silent-state epigenetic marks including histone and DNA methylation, a loss of nuclear factor-kappaB (NF-kappaB) recruitment, and requires Argonaute 1 (Ago-1), histone deacetylase 1 (HDAC-1), and DNA methyltransferase 3a (DNMT3a) localization to the LTR. Long-term suppression of the virus was observed for 1 month with no evidence of viral resistance. These data show that RNA-directed transcriptional silencing of HIV-1 can be delivered by a mobilization-competent vector, suggesting that this system could be used to target long-term selective pressures on conserved promoter elements to evolve less pathogenic variants of HIV-1.

Mathematical Study of a Staged-Progression HIV Model with Imperfect Vaccine

A staged-progression HIV model is formulated and used to investigate the potential impact of an imperfect vaccine. The vaccine is assumed to have several desirable characteristics such as protecting against infection, causing bypass of the primary infection stage, and offering a disease-altering therapeutic effect (so that the vaccine induces reversal from the full blown AIDS stage to the asymptomatic stage). The model, which incorporates HIV transmission by individuals in the AIDS stage, is rigorously analyzed to gain insight into its qualitative features. Using a comparison theorem, the model with mass action incidence is shown to have a globally-asymptotically stable disease-free equilibrium whenever a certain threshold, known as the vaccination reproduction number, is less than unity. Furthermore, the model with mass action incidence has a unique endemic equilibrium whenever this threshold exceeds unity. Using the Li-Muldowney techniques for a reduced version of the mass action model, this endemic equilibrium is shown to be globally-asymptotically stable, under certain parameter restrictions. The epidemiological implications of these results are that an imperfect vaccine can eliminate HIV in a given community if it can reduce the reproduction number to a value less than unity, but the disease will persist otherwise. Furthermore, a future HIV vaccine that induces the bypass of primary infection amongst vaccinated individuals (who become infected) would decrease HIV prevalence, whereas a vaccine with therapeutic effect could have a positive or negative effect at the community level.

A point of view: HIV-1/AIDS is an allergy but CpG ODN treatments may inhibit virus replication and reactivate the adaptive immunity--hypothesis and implications

Reevaluation of the increase in the levels of IgE and IL-4 in sera of HIV-1 infected and AIDS patients led to the suggestion that AIDS resembles allergy. Studies on the properties of the viral shed gp120 revealed that it resemble environmental allergens in their ability to induce hematopoietic cells to release large amounts of Th2 cytokines, inhibitors of the patients adaptive immune response. Yet, induction of TLR9+ plasmacytoid DCs by CpG ODNs cause the release of type I interferons, inhibitors of HIV-1 replication and IL-4 release from hematopoietic cells. CpG ODN binding to TLR+ B cells inhibits IgE synthesis and reactivates the failing adaptive immunity. The possible use of CpG ODNs as treatment to patients is discussed.

Could disease-modifying HIV vaccines cause population-level perversity?

Most current candidate HIV vaccines seem to produce little protection against infection, but reduce viral load and slow the decline in CD4 lymphocyte numbers. Such disease-modifying vaccines could potentially provide important population-level benefits by reducing transmission, but could possibly also increase transmission. We address the following question: could disease-modifying HIV vaccines cause population-level perversity (ie, increase epidemic severity)? By analysing a mathematical model and defining a new quantity-the fitness ratio-we show that disease-modifying vaccines that provide only a low degree of protection against infection and/or generate high fitness ratios will have a high probability of making the epidemic worse. However, we show that if disease-modifying vaccines cause a 1.5 log(10) reduction in viral load (or greater) then perversity cannot occur (assuming risk behaviour does not increase). Finally, we determine threshold surfaces for risk behaviour change that determine the boundary between beneficial and perverse outcomes; the threshold surfaces are determined by the fitness ratio, the proportion of the population that are "successfully vaccinated", and the degree of change of risk behaviour in unvaccinated infected individuals. We discuss the implications of our results for designing optimal vaccination control strategies.