A Renewed Commitment to HIV Vaccine Development Despite Advancements in Antiretrovirals | AIDS 2024

Today, at the International AIDS Conference in Munich, Germany, experts addressed the frequently asked questions of whether we still need to prioritize an HIV vaccine given the advancements in antiretroviral therapies and HIV PrEP.

The HIV vaccine field has recently faced significant setbacks, with trials such as PrepVacc, Mosaico and Imbokodo ending early due to lack of preventive efficacy, according to the International Aids Society.

Although there have been challenges, scientists have made discoveries showing that the immune system can be prepared to fight HIV with special antibodies. These breakthroughs are crucial for developing an HIV vaccine based on solid research and evidence.

However, with long-acting antiretrovirals like Gilead's lenacapavir and ViiV Healthcare’s cabotegravir available, there is ongoing debate about the need and urgency of pursuing an HIV vaccine given these effective treatment options.

Jeannie Marrazzo, director of the National Institute of Allergies and Infectious Diseases (NIAID) highlighted during her co-presentation that these discussions should be celebrated due to the “rich options” of therapies that are available today.

“We at NIAID, and I think in general, the scientific field, are 100% committed to continuing to work full speed and very deeply on the development of an HIV vaccine,” Marrazzo said. “The process has been an incredible path to basic discovery science that has led to a better understanding of the immunology required to generate protection. This has taken us in directions we couldn’t have envisioned 10, let alone 20 years ago."

Marrazzo emphasized that achieving a cure and eliminating HIV must involve an HIV vaccine.

“These are incredible tools that we're beginning to bring forward, but I don't think that we're going to get there with antiviral therapy as prevention alone,” she said.

“I think we cannot, and I've said this before, take our foot off the gas to advance vaccine science,” she added. “With the incredibly exciting publications and results that have come out just in the last six months, the path forward is much clearer than it ever has been. Now is not the time to quit.”

Also during the session, Maureen Luba of the International AIDS Society in Malawi and a Program Manager at Cooper Smith, highlighted significant financial barriers to accessing HIV vaccines.

Luba shared that while the need for an HIV vaccine remains critical, financial constraints impede progress, especially in low and middle-income countries.

"We are in a time where the HIV landscape is facing a very difficult time in terms of funding," Luba stated, noting that HIV funding is at a standstill. Governments in these regions are continually urged to domestically finance their HIV responses.

Although there are available HIV prevention tools, structural barriers still limit access, with only about 6 million people having initiated PrEP since its introduction.

She stressed the need for sustained funding for HIV vaccine research and development, collaboration between researchers and the industry and the importance of local manufacturing capacity in Africa.

Luba added that an HIV vaccine could potentially address cost concerns and improve access, particularly for those less likely to engage with traditional healthcare settings.

In a panel session at the end of the presentation, Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative (IAVI) agreed, adding that those in the pharmaceutical industry need to move forward with the HIV vaccine effort.

“I'm happy to say that we, I think, have a clear path forward. Whether it will be successful or not, I don't know, but it's really important that we maintain the commitment to that goal,” he said.