Challenges in the development of an effective HIV vaccine: current approaches and future directions.

OBJECTIVE: The intent of this review is to investigate and discuss why developing a successful HIV vaccine has been so challenging, first by examining the molecular biology of the virus and how HIV interacts with the immune system, and then reviewing past viral vaccine successes as well as future directions for HIV vaccine research.
BACKGROUND: Since HIV appeared in the United States in the early 1980s, an estimated 40 million people worldwide have been infected with the virus. Despite promising advances in the pharmacotherapy of HIV infection, it is apparent that the best, most cost-effective strategy for controlling the further spread of the virus is through synthesis of a protective vaccine. Almost 2 decades into the epidemic, there are few prospects for a truly effective vaccine entering the market in the foreseeable future.
METHODS: MEDLINE was searched for articles written between 1966 and June 1999. Search terms used were AIDS, HIV vaccine, HIV-1, HIV-2, vaccines, and human immunodeficiency virus.
RESULTS: Only 2 candidates for an HIV vaccine are currently in phase III clinical trials (1 in the United States and 1 in Thailand). The efficacy of these vaccines when applied to the population as a whole is widely questioned, largely because they induce protection by an antibody response only. Several studies have suggested that this approach will likely be ineffective in providing any real protection from viral infection. It appears that a strong cellular immune response is necessary in addition to a strong antibody response.