Review of preventative HIV vaccine clinical trials in South Africa
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REVIEW
Review of preventative HIV vaccine clinical trials in South Africa Fatima Laher1 · Linda‑Gail Bekker2 · Nigel Garrett3,4 · Erica M. Lazarus1 · Glenda E. Gray1,5 Received: 11 May 2020 / Accepted: 15 July 2020 © The Author(s) 2020
Abstract New HIV infections continue relentlessly in southern Africa, demonstrating the need for a vaccine to prevent HIV subtype C. In South Africa, the country with the highest number of new infections annually, HIV vaccine research has been ongoing since 2003 with collaborative public-private-philanthropic partnerships. So far, 21 clinical trials have been conducted in South Africa, investigating seven viral vectors, three DNA plasmids, four envelope proteins, five adjuvants and three monoclonal antibodies. Active vaccine candidates have spanned subtypes A, B, C, E and multi-subtype mosaic sequences. All were well tolerated. Four concepts were investigated for efficacy: rAd5-gag/pol/nef showed increased HIV acquisition in males, subtype C ALVAC/gp120/MF59 showed no preventative efficacy, and the trials for the VRC01 monoclonal antibody and Ad26.Mos4.HIV/subtype C gp140/ aluminum phosphate are ongoing. Future trials are planned with DNA/viral vector plus protein combinations in concert with pre-exposure prophylaxis, and sequential immunization studies with transmitted/ founder HIV envelope to induce broadly neutralizing antibodies. Finally, passive immunization trials are underway to build on the experience with VRC01, including single and combination antibody trials with an antibody derived from a subtypeC-infected South African donor. Future consideration should be given to the evaluation of novel strategies, for example, inactivated-whole-virus vaccines.
Introduction Handling Editor: Tim Skern. * Fatima Laher [email protected] Linda‑Gail Bekker linda‑gail.bekker@hiv‑research.org.za Nigel Garrett [email protected] Erica M. Lazarus [email protected] Glenda E. Gray [email protected] 1
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2
The Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
3
Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
4
Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
5
South African Medical Research Council, Cape Town, South Africa
The geographical disparity of the annual 1.7 million new human immunodeficiency virus (HIV) infections [1] substantiates that southern Africa is most in need of a preventative vaccine. Subtype C predominates in southern Africa [2], where a third of the world’s new infections occur. In 2018, South Africa (n = 240,000) and Mozambique (n = 150,000) accounted for the highest numbers of new infections, almost a quarter of global infections [1]. In this millennium, greater attention is being given to developing HIV vaccines in South Africa with efforts spanning from the characterization of subtype C
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