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Where now for AIDS vaccines?

BMJ 1998; 317 doi: (Published 18 July 1998) Cite this as: BMJ 1998;317:163

The recent announcement that a promising vaccine, when tested in monkeys, caused AIDS rather than prevented it has produced a mixed reaction in the scientific community, writes Scott Gottlieb. Some leading researchers were critical of attenuated vaccines long before the latest announcement, but others maintain that this type of vaccine still holds the most promise for HIV prevention

A live attenuated vaccine based on a strain of simian immunodeficiency virus had long been considered the best hope for an AIDS vaccine. The virus was weakened by the deletion of information from three genes thought to be necessary for causing the disease. When it was first tested on macaque monkeys it protected them from normally lethal doses of the full strength virus.

In 1995, however, Dr Ruth Ruprecht of the Dana Farber Cancer Institute in Boston found that the weakened virus eventually triggered the simian version of AIDS when given to baby monkeys. The new findings, reported at the 12th world AIDS conference in Geneva by Dr Ruprecht, showed that in time the vaccine also caused AIDS in adult monkeys: “What we saw in infants is a fast forward version of what could happen in adults with an attenuated vaccine.”

Live attenuated vaccines are based on deletion of the nef gene and certain other accessory sequences thought to be necessary …

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