POTENTIAL IMPACT OF LOW EFFICACY HIV-1 VACCINES IN POPULATIONS WITH HIGH-RATES OF INFECTION
POTENTIAL IMPACT OF LOW EFFICACY HIV-1 VACCINES IN POPULATIONS WITH HIGH-RATES OF INFECTION
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DOI：
10.1098/rspb.1995.0129
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发表时间：
1995-08-22
影响因子：
4.7
通讯作者：
GARNETT, GP
中科院分区：
文献类型：
--
作者：
ANDERSON, RM;SWINTON, J;GARNETT, GP
迫切需要一种安全有效的艾滋病毒疫苗来预防感染和/或减轻疾病。由于各种原因，研究进展比预期的要慢，包括不确定使用哪种免疫原（即重组亚基包膜蛋白或整个HIV-1产品），混淆哪些免疫标记物与保护最相关，HIV-1黑猩猩模型与人类感染的相关性以及HIV-1快速进化的重要性，病毒的不同分支在世界不同地区出现。然而，重组包膜糖蛋白疫苗I期和II期试验的一些令人鼓舞的结果提出了一个问题，即现在是否应该在具有低至中等疗效的免疫原的人体中进行III期试验。通过使用数学模型和流行病学研究的数据，我们研究了此类疫苗在高感染率的异性恋社区中的潜在影响。分析表明，即使有非常高水平的大规模疫苗接种，也很难阻断HIV-1的传播。用保护期短的疫苗维持高水平的群体免疫力的成本可能很高。然而，对艾滋病毒-1流行长期影响的评估表明，许多艾滋病毒感染和相关死亡病例可以通过免疫原预防，其效力为50%或更低，保护期为五年。这些分析在一定程度上支持了这样一种观点，即在艾滋病毒高传播地区进行III期疗效试验可能是合适的，即使对免疫原的潜在疗效的共识是它会很低。
A safe and effective HIV vaccine to prevent infection and/or to moderate disease is urgently needed. Research progress has been slower than anticipated for a variety of reasons including uncertainty over which immunogen to use (i.e.; recombinant subunit envelope proteins or whole HIV-1 products), confusion an which immunological markers best correlate with protection, the relevance of the HIV-I chimpanzee model to infection in humans and the significance of the rapid evolution of HIV-1, with different clades of the virus emerging in different parts of the world. However, what some would interpret as encouraging results, from Phase I and II trials of recombinant envelope glycoprotein vaccines, have raised the question of whether the time is right to start Phase III trials in humans with immunogens that may have low to moderate efficacy. By using mathematical models and data from epidemiological studies, we examine the potential impact of such vaccines within heterosexual communities with high rates of infection. Analyses suggest that it will be difficult to block HIV-1 transmission even with very high levels of mass vaccination. The cost of sustaining high levels of herd immunity with a vaccine of short protection duration is likely to be high. However, assessments of impact over the long duration of an HIV-1 epidemic indicate that many cases of HIV infection and associated mortality can be prevented by immunogens with efficacy of 50% or less and a five year protection duration. These analyses add some support to the view that proceeding with Phase III efficacy trials may be appropriate in high HIV transmission regions even if the consensus opinion on potential efficacy of the immunogen is that it will be low.