McElrath M Juliana
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Curr Opin HIV AIDS. 2017 May;12(3):278-284. doi: 10.1097/COH.0000000000000365.
The development and availability of new-generation adjuvants beyond aluminum and emulsion formulations, together with a deeper understanding of the mechanistic role of adjuvant formulations in stimulating innate immunity and offer opportunities to improve candidate vaccine designs intended to protect against HIV-1 acquisition.
Currently, major efforts in vaccine development focus on improving prime-boost vaccine regimens to enhance efficacy beyond 31% observed in the RV144 phase 3 study and to develop a pathway to induce broadly reactive HIV neutralizing antibodies. Advances in HIV-1 envelope (Env) immunogen design and improved adjuvant formulations are moving at a parallel pace. This review highlights steps underway to rationally pair vaccine concepts with improved adjuvant formulations in preclinical and early phase 1 clinical evaluation.
New adjuvants with immune-potentiating properties are currently being tested in combination with recent HIV Env-containing immunogens in prime-boost and subunit protein-only regimens. Greater emphasis is being applied to formulation science, delivery, and targeted safety and immune evaluation with these adjuvants in clinical trials. The need to develop an HIV vaccine that induces more potent and long-lived protective immunity will necessitate continued efforts to optimize adjuvanted vaccine formulations.
新一代佐剂的研发及其可用性已超越铝盐和乳剂配方，同时人们对佐剂配方在刺激先天免疫中的作用机制有了更深入的了解，这为改进旨在预防HIV-1感染的候选疫苗设计提供了机会。
目前，疫苗研发的主要工作集中在改进初免-加强疫苗方案，以提高疗效，使其超过RV144 3期研究中观察到的31%，并开发出诱导广泛反应性HIV中和抗体的途径。HIV-1包膜（Env）免疫原设计的进展和改进的佐剂配方正在同步推进。本综述重点介绍了在临床前和1期临床早期评估中，将疫苗概念与改进的佐剂配方合理配对的进展情况。
目前正在测试具有免疫增强特性的新型佐剂与近期含HIV Env的免疫原在初免-加强和仅亚单位蛋白方案中的联合使用情况。在临床试验中，人们更加重视这些佐剂的配方科学、给药方式以及靶向安全性和免疫评估。开发一种能诱导更有效和持久保护性免疫的HIV疫苗的需求，将需要继续努力优化佐剂疫苗配方。
