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http://www.latimes.com/news/custom/scimedemail/la-oew-khanlou25apr25,0,7034531.story

 From the Los Angeles Times

BLOWBACK

No results? No research money.

When even scientists acknowledge that 25 years of research haven't 
born any fruit, it's time to stop searching for an AIDS vaccine.

By Homayoon Khanlou and Michael Weinstein

April 25, 2008

The search for an AIDS vaccine has lost its scientific purpose and 
turned into a self-serving quest.

How else to explain the remarks found in David Baltimore and Seth 
Berkley's 
<http://www.latimes.com/news/opinion/la-oew-baltimore14apr14%2C0%2C2709040.story>"Keep 
funding the AIDS vaccine"? Saying simply that "AIDS vaccine 
development is hard" is not a credible response to recent criticism 
leveled at the ballooning U.S. budget for AIDS vaccine research and 
the meager results it has produced. The argument is particularly weak 
when you consider that nearly $1 billion in public funding is poured 
annually into this fruitless quest, while millions globally lack 
access to the revolutionary, life-saving AIDS treatment that was 
developed more than 12 years ago: antiretroviral medication.

The recent Merck vaccine trial that Baltimore and Berkley mention was 
not only a failure, it actually endangered lives by increasing the 
likelihood that study participants would contract the virus. The 
Merck trial was also not an anomaly. There have been 25 years of 
repeated AIDS vaccine failures at high cost to taxpayers. To call for 
more human clinical research -- as Baltimore and Berkley do -- defies 
common sense and endangers lives. Important insights into the basic 
mechanisms of the virus and the human body's response to it are still 
missing. So where is the science to back up their call for more 
money? And can such an expense be justified if measured in human 
lives lost because of lack of access to treatment that can cost as 
little as 50 cents a day?

The best way to break the chain of infection is to prevent an 
infected person from passing it on to others. A number of 
extraordinarily effective approaches to achieve this already exist. 
The spread of infection would be significantly curbed if we focused 
primarily on the source of all new infections: the 33 million people 
who are currently estimated to be carrying the virus. Effective pre- 
and/or post-exposure prophylaxis treatments are an example of a 
possible approach. A focused antiretroviral pre-prophylaxis effort in 
high-risk populations, such as commercial sex workers, would be a 
highly cost-effective way to prevent the spread of infection.

There is also 
<http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=50131>mounting 
evidence to demonstrate that patients with undetectable viral loads 
-- achieved through antiretroviral treatment -- have a much lower 
rate of transmission, perhaps a rate even lower than could be 
achieved with a successful vaccine. Still, these lifesaving drugs are 
currently unavailable to all but the smallest fraction of the people 
who need them. What might a nearly $1-billion annual investment in 
the worldwide scale-up of antiretroviral treatment buy in terms of 
transmissions prevented?

In a post-Merck-failure research climate, the scientific community 
has come to a consensus: an investment in basic science is needed. 
Such research does not require the enormous, and enormously 
expensive, global clinical trial apparatus currently in place for 
AIDS vaccine research. In fact, according to 
<http://www.iavi.org/viewfile.cfm?fid=48242>recent reports, 
researchers with Berkeley's International AIDS Vaccine Initiative and 
the Center for HIV/AIDS Vaccine Immunology -- employing funds from 
the U.S. HIV vaccine research pot -- plan to focus on such areas of 
basic science research as the genetic sequencing of new HIV viruses, 
an investigation into how genetic factors might control HIV infection 
and inquiry into the possible reasons why some people exposed to HIV 
do not progress to AIDS. However, the U.S. government already 
allocates several billion dollars a year to funding basic AIDS 
research. So what is the purpose of setting aside another $1 billion 
annually under a separate HIV vaccine research umbrella?

To date, there has been no evidence that there will ever be an AIDS 
vaccine. In fact, in 
<http://www.independent.co.uk/news/science/is-it-time-to-give-up-the-search-for-an-aids-vaccine-814737.html>apoll 
of more than 35 top HIV/AIDS scientists in Britain and the U.S. 
conducted by Britain's Independent newspaper and published this week, 
"nearly two-thirds believed that an HIV vaccine will not be developed 
within the next 10 years" and a "substantial minority of the 
scientists admitted that an HIV vaccine may never be developed."

Resources are not limitless. To date, there has been no evidence that 
there will ever be an AIDS vaccine. It is time for an honest 
reassessment of funding priorities and a redeployment of resources 
into delivering antiretroviral medications to the people who need it. 
It is time to pull the plug on U.S. public funding for HIV vaccine 
research.

After all, can you think of any other U.S. enterprise that has been 
studied and investigated for 25 years and on which many billions of 
dollars have been spent without any results?

Homayoon Khanlou, MD, is chief of medicine, U.S., and Michael 
Weinstein is president of the 
<http://www.aidshealth.org/nh/index.html>AIDS Healthcare Foundation.