Viral diversity as a challenge to HIV-1 vaccine development.

PURPOSE OF REVIEW: This review attempts to acquaint the reader with the molecular epidemiology of HIV-1 and to describe some of the more promising approaches to vaccine development in the light of this diversity. RECENT
FINDINGS: The primary genetic forms of HIV-1 in the world today are subtypes A, B, C, CRF01-AE and CRF02-AG. In sub-Saharan Africa, subtypes A and C and CRF02-AG account for most of the infections. In Asia, there are subtypes B, C and CRF01 AE. Europe, the Americas and the Caribbean are dominated by subtype B, and subtype A is in the former Soviet Union. While the genetic diversity of HIV-1 in the world can seem daunting, the vast majority of infections are actually caused by one of these five genetic forms. Approaches to dealing with this in the development of vaccines include targeting conserved regions of the genome, creating ancestral forms of the virus or putting many different forms together into a cocktail. Each of these approaches shows promise. To optimize the chances of initially showing efficacy in HIV vaccine trials, the genetic form of the vaccine strains will resemble those of the circulating strains in the target population. Once efficacy is demonstrated, however, it will be possible to determine whether genetic subtype is at all predictive of vaccine protection.
SUMMARY: Although the genetic diversity of HIV-1 is impressive, it is not limitless. Most of the infections worldwide are actually due to a handful of strains. It should be possible for a few vaccine strategies to conquer HIV-1 definitively.