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Ng'uni T, Chasara C, Ndhlovu ZM. Major Scientific Hurdles in HIV Vaccine Development: Historical Perspective and Future Directions. Front Immunol 2020; 11:590780. [PMID: 33193428 PMCID: PMC7655734 DOI: 10.3389/fimmu.2020.590780] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022] Open
Abstract
Following the discovery of HIV as a causative agent of AIDS, the expectation was to rapidly develop a vaccine; but thirty years later, we still do not have a licensed vaccine. Progress has been hindered by the extensive genetic variability of HIV and our limited understanding of immune responses required to protect against HIV acquisition. Nonetheless, valuable knowledge accrued from numerous basic and translational science research studies and vaccine trials has provided insight into the structural biology of the virus, immunogen design and novel vaccine delivery systems that will likely constitute an effective vaccine. Furthermore, stakeholders now appreciate the daunting scientific challenges of developing an effective HIV vaccine, hence the increased advocacy for collaborative efforts among academic research scientists, governments, pharmaceutical industry, philanthropy, and regulatory entities. In this review, we highlight the history of HIV vaccine development efforts, highlighting major challenges and future directions.
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Affiliation(s)
- Tiza Ng'uni
- KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Caroline Chasara
- KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Zaza M Ndhlovu
- KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA, United States
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Chuang DM, Newman PA, Weaver J. HIV Vaccine Preparedness among Men Who Have Sex with Men in Taiwan: Sociocultural and Behavioral Factors. J Int Assoc Provid AIDS Care 2020; 18:2325958219832285. [PMID: 30907256 PMCID: PMC6748505 DOI: 10.1177/2325958219832285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In Taiwan, men who have sex with men (MSM) are at disproportionate risk of HIV infection. We examined awareness and acceptability of future HIV vaccines. From July to August 2014, we conducted a cross-sectional survey with MSM recruited through community-based organizations (CBOs) in 2 cities. Among 200 participants (mean age, 27.6 years), half reported multiple partners and one-third condomless anal sex (past 3 months); 12% were HIV-positive. Traditional Chinese medicine (TCM) use was reported by 42.7%. Over two-thirds (69.0%) were aware of HIV vaccine research, but less than half (43.8%) would accept an HIV vaccine if available. In multivariable analysis, higher educational attainment, >5 sex partners, and TCM use were positively associated with HIV vaccine awareness. Culturally informed HIV vaccine preparedness in Taiwan may be supported by a complementary approach to TCM and HIV prevention technologies, tailoring information for MSM with lower education and targeting those at high risk through gay-identified CBOs.
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Affiliation(s)
- Deng-Min Chuang
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Peter Adam Newman
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - James Weaver
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
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Liu P, Xing H, Liao L, Feng Y, Leng X, Wang J, Kan W, Yan J, Li Y, Zuo Z, You Y, Ruan Y, Shao Y. HIV drug resistance in patients in China's national HIV treatment programme who have been on first-line ART for at least 9 months. AIDS Res Ther 2020; 17:9. [PMID: 32138739 PMCID: PMC7059326 DOI: 10.1186/s12981-020-00264-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess trends in drug resistance and associated clinical and programmatic factors at a national level during the rapid scale up of ART. METHODS Logistic regression was used to identify the factors associated with HIVDR. Variables associated with drug resistance in multivariable logistic regression were included in the Cochran-Armitage test for trend. RESULTS A total of 11,976 patients were enrolled in the study. The prevalence of HIVDR among patients who received ART for 9-24 months during 2003-2008, 2009-2012, and 2013-2015 significantly decreased (15.5%, 6.3%, and 2.3%, respectively, P < 0.01). With respect to the class of antiretroviral, there were substantial increases in resistance to both non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) (2003-2008, 2009-2012, and 2013-2015: 49.7%, 58.9%, and 73.0%, respectively, P < 0.01). The prevalence of DR to protease inhibitors (PIs) was low, which supported their continued use as second-line therapy in China. CONCLUSIONS Our results provide evidence for the effectiveness of China's "Treat All" approach to guide policy makers to improve training for healthcare providers and education on ART adherence among patients.
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Trattnig N, Blaukopf M, Bruxelle JF, Pantophlet R, Kosma P. Synthesis of an Undecasaccharide Featuring an Oligomannosidic Heptasaccharide and a Bacterial Kdo-lipid A Backbone for Eliciting Neutralizing Antibodies to Mammalian Oligomannose on the HIV-1 Envelope Spike. J Am Chem Soc 2019; 141:7946-7954. [PMID: 31010286 PMCID: PMC6524000 DOI: 10.1021/jacs.9b02872] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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Lipooligosaccharides (LOS) from the
bacterium Rhizobium
radiobacter Rv3 are structurally related to antigenic mammalian
oligomannoses on the HIV-1 envelope glycoprotein spike that are targets
for broadly neutralizing antibodies. Here, we prepared a hybrid structure
of viral and bacterial epitopes as part of a vaccine design strategy
to elicit oligomannose-specific HIV-neutralizing antibodies using
glycoconjugates based on the Rv3 LOS structure. Starting from a Kdo2GlcNAc2 tetrasaccharide precursor, a central orthogonally
protected mannose trichloroacetimidate donor was coupled to OH-5 of
the innermost Kdo residue. To assemble larger glycans, the N-acetylamino groups of the glucosamine units were converted
to imides to prevent formation of unwanted imidate byproducts. Blockwise
coupling of the pentasaccharide acceptor with an α-(1→2)-linked
mannotriosyl trichloroacetimidate donor introduced the D1-arm fragment.
Glycosylation of O-6 of the central branching mannose
with an α-(1→2)-α-(1→6)-linked mannotriosyl
trichloroacetimidate donor unit then furnished the undecasaccharide
harboring a D3-arm extension. Global deprotection yielded the 3-aminopropyl
ligand, which was activated as an isothiocyanate or adipic acid succinimidoyl
ester and conjugated to CRM197. However, representative
oligomannose-specific HIV-neutralizing antibodies bound the undecasaccharide
conjugates poorly. Possible reasons for this outcome are discussed
herein along with paths for improvement.
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Affiliation(s)
- Nino Trattnig
- Department of Chemistry , University of Natural Resources and Life Sciences , A-1190 Vienna , Austria
| | - Markus Blaukopf
- Department of Chemistry , University of Natural Resources and Life Sciences , A-1190 Vienna , Austria
| | | | | | - Paul Kosma
- Department of Chemistry , University of Natural Resources and Life Sciences , A-1190 Vienna , Austria
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Bhatia T, Enoch J, Khan M, Mathewson S, Heymann D, Hayes R, Dar O. Setting targets for HIV/AIDS-What lessons can be learned from other disease control programmes? PLoS Med 2019; 16:e1002735. [PMID: 30716068 PMCID: PMC6361469 DOI: 10.1371/journal.pmed.1002735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In a Collection Review, Richard Hayes and colleagues discuss metrics for assessing progress in control of the HIV/AIDS epidemic in the context of prior disease control programmes.
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Affiliation(s)
| | - Jamie Enoch
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie Mathewson
- Chatham House Centre on Global Health Security, London, United Kingdom
| | - David Heymann
- Public Health England, London, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Chatham House Centre on Global Health Security, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Osman Dar
- Public Health England, London, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Chatham House Centre on Global Health Security, London, United Kingdom
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Rubincam C, Newman PA, Atujuna M, Bekker LG. 'Why would you promote something that is less percent safer than a condom?': Perspectives on partially effective HIV prevention technologies among key populations in South Africa. SAHARA J 2018; 15:179-186. [PMID: 30360675 PMCID: PMC6211311 DOI: 10.1080/17290376.2018.1536561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
New biomedical prevention technologies (NPTs) for HIV, including oral Pre-Exposure Prophylaxis, and vaginal and rectal microbicides and HIV vaccines in development, may contribute substantially to controlling the HIV epidemic. However, their effectiveness is contingent on product acceptability and adherence. We explored perceptions and understanding of partially effective NPTs with key populations in South African townships. From October 2013 to February 2014, we conducted six focus groups and 18 individual interviews with Xhosa-speaking adolescents (n = 14), adult men who have sex with men (MSM) (n = 15), and adult heterosexual men (n = 9) and women (n = 10), and eight key informant (KI) interviews with healthcare workers. Interviews/focus groups were transcribed and reviewed using a thematic approach and framework analysis. Overall, participants and KIs indicated scepticism about NPTs that were not 100% efficacious. Some participants equated not being 100% effective with not being completely safe, and thus not appropriate for dissemination. KIs expressed concerns that promoting partially effective NPTs would encourage substitution of a more effective with a less effective method or encourage risk compensation. Educational and social marketing interventions that address the benefits and appropriate use of partially effective NPTs, including education and support tailored for frontline service providers, are needed to prepare for successful NPT implementation in South Africa.
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Affiliation(s)
- Clara Rubincam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, Institute of Infectious Disease, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Disease, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
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Damjanovic D, He L, Symes J, Gajewska B, Azizi A, Salha D, Ettorre L, Bernardo-Reyes L, Su J, Phogat S, Gisonni-Lex L. In vitro assessment of biological activity and stability of the ALVAC-HIV vaccine. Vaccine 2018; 36:5636-5644. [DOI: 10.1016/j.vaccine.2018.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 01/21/2023]
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Pillay D, Wassenaar DR. Racial differences in willingness to participate in HIV prevention clinical trials among university students in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317708094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Students, especially women, are in the highest HIV incidence group in Sub-Saharan Africa. Willingness to participate is a crucial element in recruitment of participants for clinical trials, including HIV prevention trials. There is increasing incidence of HIV among university students, highlighting the importance of evaluating their willingness to participate in prevention trials. Assessment of willingness to participate assists in determining community preparedness for trials. This cross-sectional study aimed to evaluate willingness to participate and explore racial differences and factors associated with willingness to participate in HIV prevention research. The Clinical Research Involvement Scale and demographic questionnaire were administered online to university students aged 18–45 years at the University of KwaZulu-Natal in South Africa. The instruments evaluated associations between willingness to participate and age, gender, relationship status, parity, religion, education, student and employment status, and access to private health care. This study enrolled 636 participants, of which 509 records were analysable. Most students were willing to participate in HIV prevention research irrespective of race. However, Black students expressed greater intention to participate compared to White and Indian students. Racial differences in factors that affect intentions to participate were differences in risk perception and seeking access to better quality health care. The Clinical Research Involvement Scale is a reliable instrument in this population. Validity improved with removal of factors, motivation to comply, and outcome evaluations. These findings may not be generalizable to other student populations in Southern Africa.
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Affiliation(s)
- Diantha Pillay
- School of Family and Public Health Medicine, University of KwaZulu-Natal, South Africa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Douglas R Wassenaar
- South African Research Ethics Training Initiative (SARETI), School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
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