U.S. Military HIV Research Program (MHRP), Bethesda, Maryland 20817, USA.
Curr Opin HIV AIDS. 2013 Sep;8(5):421-31. doi: 10.1097/COH.0b013e3283632c26.
Considerable HIV-1 vaccine development efforts have been deployed over the past decade. Put into perspective, the results from efficacy trials and the identification of correlates of risk have opened large and unforeseen avenues for vaccine development.
The Thai efficacy trial, RV144, provided the first evidence that HIV-1 vaccine protection against HIV-1 acquisition could be achieved. The correlate of risk analysis showed that IgG antibodies against the gp120 V2 loop inversely correlated with a decreased risk of infection, whereas Env-specific IgA directly correlated with risk. Further clinical trials will focus on testing new envelope subunit proteins formulated with adjuvants capable of inducing higher and more durable functional antibody responses (both binding and broadly neutralizing antibodies). Moreover, vector-based vaccine regimens that can induce cell-mediated immune responses in addition to humoral responses remain a priority.
Future efficacy trials will focus on prevention of HIV-1 transmission in heterosexual population in Africa and MSM in Asia. The recent successes leading to novel directions in HIV-1 vaccine development are a result of collaboration and commitment among vaccine manufacturers, funders, scientists and civil society stakeholders. Sustained and broad collaborative efforts are required to advance new vaccine strategies for higher levels of efficacy.
在过去的十年中，已经投入了相当多的 HIV-1 疫苗研发工作。从疗效试验的结果和风险相关因素的确定来看，这为疫苗的开发开辟了广阔的、意料之外的途径。
泰国的疗效试验 RV144 首次提供了 HIV-1 疫苗预防 HIV-1 感染的保护作用的证据。风险相关因素分析表明，针对 gp120 V2 环的 IgG 抗体与感染风险降低呈负相关，而 Env 特异性 IgA 则与风险呈正相关。进一步的临床试验将集中测试新的包膜亚单位蛋白，这些蛋白与能够诱导更高和更持久的功能性抗体反应（包括结合和广泛中和抗体）的佐剂一起使用。此外，能够诱导细胞免疫反应以及体液免疫反应的基于载体的疫苗方案仍然是一个优先事项。
未来的疗效试验将集中在预防非洲异性恋人群和亚洲男男性接触者中的 HIV-1 传播。最近的成功导致了 HIV-1 疫苗开发的新方向，这是疫苗制造商、资助者、科学家和民间社会利益相关者之间合作和承诺的结果。需要持续和广泛的合作努力来推进新的疫苗策略，以提高疗效。
