Vaccine Development
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Education is the only means of HIV prevention currently available. Over the past few years significant efforts have been directed toward the development of an effective vaccine against HIV. Although substantial progress has been achieved, several obstacles still remain. Despite enormous advances in understanding the immunopathogenesis of HIV infection, the precise mechanism of protective immunity remains unknown.
Without such knowledge, it is difficult to develop vaccines that are assured of targeting the appropriate arm of the immune system that confers long-term protective immunity. Another obstacle is the lack of correlation of data from animal models to the potential protective effects of vaccines in humans. Therefore, even if an effective vaccine were available, it would take years of human testing to demonstrate its effectiveness.
Moreover, once a candidate vaccine is in human trials, the relatively low rate of HIV transmission and, in some cases, the difficulty in determining whether HIV infection has actually occurred will complicate the evaluation process.
Despite the enormous progress made in vaccine development over the last few years, it will take several more years before protective efficacy can be established. Even if an effective vaccine is established, education will remain the primary mode of HIV prevention, owing to the difficulty in knowing how long the protective immune effect will last.
Never before has so much been known about an epidemic during the time it was occurring. The challenge is to disseminate the knowledge to populations at risk in language they can understand and, ultimately, to modify activities so that the risk of transmission is minimized.
Preferences:
Bell DM: Occupational risk of human immunodeficiency virus infection in healthcare workers: An overview. Am J Med 102 (Suppl 5B), 9-15, 1997. A thorough overview of risks of HIV transmission. Part of a dedicated supplement to the American Journal of Medicine on this subject.
Centers for Disease Control: Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(Suppl 2):1S, 1987. Original description of universal precautions. Critical reading for all health care providers.
Centers for Disease Control: Update: Investigations of persons treated by HIV-infected health-care workers--United States. MMWR 42:329, 1993. Summary of look-back studies that examine the status of patients who received care from HIV-infected health care workers.
Centers for Disease Control: Public Health Service guidelines for the management of health care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR 47(RR-7):1-26, 1998. A comprehensive summary of guidelines for management of HCW exposure to HIV. A “must” for employee health and infection control counselor. Extensive reference list.
Gerberding JL: Is antiretroviral treatment after percutaneous HIV exposure justified? Ann Intern Med 118:979, 1993. Succinct overview of current thinking on postexposure prophylaxis. Cites key references.
Lo B, Steinbrook R: Health care workers infected with the human immunodeficiency virus: The next steps. JAMA 267:1100, 1992. Thoughtful review of the medical, epidemiologic, and ethical issues surrounding the practice of HIV-infected health care providers.
Revision date: July 6, 2011
Last revised: by Jorge P. Ribeiro, MD
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