The most interesting point of the article for me is that this vaccine appears to be a series of shots which act as a curriculum for the immune system. Each one slightly different and targeting a different stage of B-cell development. I've never thought of vaccine series working like that, so it was a new and impressive idea.
All vaccines are training data for the immune system, which is a learning machine whose operation is a little bit like a genetic algorithm. It generates and sieves variation using a vocabulary of pre-encoded building blocks to fit the targets it's presented with.
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.
You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
Ad-hoc use of PrEP just requires that you take a double dose 1 hour prior to potential exposure, and follow up with another double dose 24 hours later, at least with the versions commonly prescribed to sexually active groups in my area.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
Cost and compliance are still 2 major factors that have not been solved.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
> If you are not doing risky sex it isn't for you.
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur...
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
> You are extremely unlikely to get HIV from anything other than risky sex.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.
"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.
For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.
Who's waiting? The problem is the populations we need to distribute it to can least afford it.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
Abstinence has been shown to be an extremely, hilariously, stupidly ineffective strategy in all questions of human sexual health.
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
Most things are a solved problem if we give up the things that make life worth living. Obesity is a solved problem if you just eat for health. Road traffic deaths are a solved problem if you never leave your house. Suicides are a solved problem if you just don't kill yourself.
I have to admit that given how many times we have been here, I struggle with being excited about any news about a HIV vaccine until we see results from humans. Just way too many times of hope.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
OK this sounds fantastic, but is it going to be another case of an expert dropping in on this thread and going "Ah, 100s of these come out every month. It's promising but nowhere near human trials yet."
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
Source: https://www.doctorswithoutborders.org/latest/campaigns/acces...
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
Condoms break. Partners lie. Shit happens.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
Vaccines are the "an ounce of prevention is worth a pound of cure"
I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
We live in a messy world.
The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:
https://www.theatlantic.com/health/archive/2019/04/dental-da...
https://slate.com/human-interest/2021/08/no-condoms-gay-sex-...
https://www.washington.edu/news/2024/02/27/qa-decline-in-con...
https://www.huffingtonpost.co.uk/entry/prep-condoms-gay-sexu...
At least a portion of the amount of people "in the closet" are closeted for fear of STDs, not particularly because of social stigma risk.
https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
It's wired into our DNA to do this, and while we can be socialised out of it, you'll never get anywhere close to the near 100% you'd need.
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
It doesn’t work. Change your mind.
If compliance with safe sex techniques were anywhere close to where it should be, this wouldn't be a problem.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
It's a positive step, but still a fair way off for humans.
This is in the "interesting advancement" stage, not "promising treatment."