Friday, May 18, 2018

Recombinants harsh to HIV vaccine development

By Esther Nakkazi

Today is World HIV vaccine day. As we celebrate the day, we have a lot of hope this time around more than ever.

For the first time in many years, four efficacy vaccine concepts are in phase III and could give us an HIV vaccine. But even if they do not it is a still a great leap forward.

“If they do not give us a vaccine they will at least give us information about how it works,” said Dr. Francis Kiweewa, the head of research and scientific affairs at Makerere University Walter Reeds Project (MUWRP).

Kiweewa said we shall get to know this important information just two to three years from today in either 2020 and 2021 and that is not far off. He was speaking to journalists at their monthly science cafe organized by Health Journalists Network in Uganda, HEJNU.

But that withstanding you could ask do we still need an HIV vaccine anyway? In some circles, the debate is could HIV be the first epidemic to be eliminated without a vaccine.

I guess you have heard of all the interventions these days, the condom, the antiretroviral therapy for both treatment and prevention, the vaginal ring that showed promising results and more to it scientists are busy in their laboratories cooking up new HIV prevention and therapeutic tools every day.

Dr. Kiweewa says despite these efforts we still need an HIV vaccine. "The numbers of new infections remain incredibly high," he says. For instance in Uganda 500 youth get infected with HIV every week. In South Africa, 5000 young women are infected with HIV every week.

Also, the high cost of treatment is unsustainable and ultimately a vaccine would be cheaper, reach many more people and let us not forget that ‘prevention is better than cure’.

Even if we get the HIV vaccine in the next two to three years, there is a possibility that it might not be suitable for us. And here is why an HIV vaccine might work elsewhere and not for Uganda or East Africans.

HIV has many sub-types, the East African region has two predominant subtypes A and D while southern Africa mostly has subtype C. The Uganda Virus Research Institute (UVRI) scientists did a research, sequencing the virus and found that 50% of the HIV virus in Uganda are recombinants of subtype A and D.

This means 50% of the estimated 1.3 million people who are infected with HIV in Uganda have a combination of subtype A and D or AD/DA. While it may not necessarily be more virulent scientists say it progresses faster.

“A vaccine has that challenge,” says Prof Pontiano Kaleebu, the director of MRC/UVRI and the London School of Tropical Medicine (LSHTM). It is for that reason and many others that the renowned professor thinks we are a forgotten lot. 

“They are forgetting us here where we have recombinants in east Africa,” said Kaleebu. In other words, the spread of recombinant forms of HIV could have implications for vaccines developed to guard against only certain sub-types and not others.

Not enough research is being done in the region, your governments are not investing enough money so that the scientists develop that vaccine that is suitable for you.  So keep the optimism but also be mindful of the future that we could walk away empty handed here where the HIV burden is highest.

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