French National Academy of Medicine, Lyon, France.
Curr Opin HIV AIDS. 2012 Jan;7(1):4-9. doi: 10.1097/COH.0b013e32834ddc96.
To review the status of HIV vaccine development
Since the discovery of HIV-1 in the early 1980s considerable effort has been exerted to develop a prophylactic vaccine, with relatively meagre results. The absence of natural immunity has proven to be a major stumbling block in identifying a mechanism of protection. However, many different animal models have contributed to our knowledge of the pathogenesis of infection and of the variety of antibody and cellular responses that are induced by the virus. The knowledge created by the studies in nonhuman primates, although important, has not necessarily been proven applicable in humans and thus an effective vaccine has been elusive. The combined lack of a fully predictive animal model ('mice lie and monkeys exaggerate') and lack of defined markers of immune protection against HIV-1 necessitate that HIV vaccines be tested directly for efficacy in phase IIb/III efficacy trials in human volunteers at risk. A trial conducted in Thailand showed moderate but significant protection against infection.
The process of HIV vaccine development is slow, costly and tedious. However, recent preclinical and clinical results have fortunately been a source of renewed optimism in the field.
回顾 HIV 疫苗开发的现状
自 20 世纪 80 年代初发现 HIV-1 以来，人们付出了相当大的努力来开发预防性疫苗，但结果相对较少。缺乏自然免疫力已被证明是确定保护机制的主要障碍。然而，许多不同的动物模型有助于我们了解感染的发病机制以及病毒诱导的各种抗体和细胞反应。虽然非人类灵长类动物研究的知识非常重要，但并不一定适用于人类，因此，有效的疫苗仍然难以捉摸。缺乏完全可预测的动物模型（“老鼠撒谎，猴子夸大”）和缺乏针对 HIV-1 的免疫保护的明确标志物，这两者共同导致 HIV 疫苗必须在人类志愿者的 IIb/III 期功效试验中直接进行功效测试，这些志愿者有感染风险。在泰国进行的一项试验显示出对感染的适度但显著的保护作用。
HIV 疫苗开发的过程缓慢、昂贵且乏味。然而，最近的临床前和临床结果幸运地为该领域带来了新的乐观情绪。
