AIDS Vaccines: Stepwise Progress Eclipsed By Drugs

The search for an effective vaccination against HIV infection has been in the doldrums for some time, with not one vaccine candidate progressing beyond Phase II trials. At the XI International Conference on AIDS in Vancouver, Canada, earlier this month, modest progress was reported with a variety of candidates, but the attention of the world was focused firmly on drug combinations and the question of eradication.

The majority of HIV-infected individuals are unlikely to have access to these new treatments in the near term. More than 90% of the more than 20.1 million people alive today with the virus live in a developing country. Sub-Saharan Africa is currently the worst-hit area, with more than 12.9 million infected. But the African situation could be dwarfed by the epidemic in Asia; at the end of 1995 the United Nations Program on HIV/AIDS estimated the number of cases at four million, but this is expected to balloon as a result of the prevalence of commercial sex and needle-sharing among injecting drug users.

Elsewhere in the world, there is a rising incidence of heterosexual transmission, initially among bisexual men and their female partners and among commercial sex workers and their clients, and latterly in the general population. Over 1.7 million adults are living with HIV/AIDS in Latin America and the Caribbean, while 1.2 million are infected in North America and western Europe. In other regions, a low prevalence has been estimated, but many other areas have many factors conducive to the spread of the virus, eg economic crisis, rising unemployment, crumbling health care systems, ethnic and religious conflicts, and the displacement of civilian populations.