Scientific Publications

Serial samples from source plasma donors with confirmed new HIV infection were investigated for low-level viremia (LLV) (ie, < 100 genome copies [cp]/mL) at time points preceding the period of steadily rising viremia above 100 cp/mL (ramp-up viremia). Fifteen of 44 plasma donor panels previously studied for the dynamics of HIV viremia during primary infection contained 70 samples with undetectable HIV-1 RNA by quantitative polymerase chain reaction (PCR). On retesting with a sensitive qualitative reverse transcriptase PCR assay (95% detection at 4 cp/mL), we identified LLV in 13 of 15 panels and 23 of 69 retested samples. In 6 panels, a total of 11 samples (1-3 per panel) were consistent with LLV before ramp-up viremia. These samples preceded the first sample with >100 cp/mL HIV by 9 to 25 days (median = 18 days) and were separated from the latter by at least 1 sample with undetectable viremia by the qualitative PCR assay. We conclude that LLV is not uncommon during the very early period of primary HIV infection preceding ramp-up viremia. It is not known if blood is infectious during this period; however, given the low viral concentrations and transient nature of the observed viremic 'blips,' the risk of infectivity can be assumed to be small.

To compare hypothetical and actual willingness to enroll in a preventive HIV vaccine trial and identify factors affecting enrollment.

The genetic diversity of human immunodeficiency virus type 1 (HIV-1) raises the question of whether vaccines that include a component to elicit antiviral T cell immunity based on a single viral genetic clade could provide cellular immune protection against divergent HIV-1 clades. Therefore, we quantified the cross-clade reactivity, among unvaccinated individuals, of anti-HIV-1 T cell responses to the infecting HIV-1 clade relative to other major circulating clades.

The worldwide quest for an AIDS vaccine represents an unprecedented scientific and human challenge for the 21st century. Preventive vaccines represent our only long-term hope to stop the epidemic. AIDS vaccines must be seen as the ultimate prevention tool that will complement the existing prevention strategies in place. The acceleration of vaccine development through the parallel exploration of several scientific approaches and implementation of clinical trials are the best and probably only way to reach this goal, and the best vaccines have moved into phase II and efficacy trials. Ideally an AIDS vaccine should induce both neutralizing antibodies against HIV-1 primary isolates and cell-mediated responses. AIDS vaccines could prevent either HIV infection or progression to disease and decrease transmission by reducing the HIV viral load. Most of the vaccine approaches developed so far aim at inducing cell-mediated immune responses. New vector-based vaccines include modified vaccinia Ankara, adeno-associated virus, adenovirus and alpha viruses. Considerable efforts are on to develop vaccines that would induce neutralizing antibodies. All vaccines tested so far in humans have proven to be safe. This long-term endeavour requires strong and renewed political leadership and commitment, flexibility of processes, medical and scientific dedication and collaboration on a mission mode along with community participation for immediate action. Recent developments in India highlight clearly the commitment of the Government of India and the scientific community to a long-term global effort to develop an AIDS vaccine.

A contingent valuation survey of Thai adults revealed that private demand for a hypothetical AIDS vaccine that is safe, has no side effects, and lasts 10 years, rises with income, the lifetime risk of HIV infection and vaccine efficacy, and declines with vaccine price and respondent's age. Demand for both high (95%) and low (50%) efficacy AIDS vaccines is substantial. Nearly 80% of adults would agree to be vaccinated with a free vaccine. Government will have an important role to ensure that those at highest risk of HIV infection with low incomes have access to the vaccine and to reinforce other safe preventive behavior to prevent reductions in condom use.

Efficient immune responses to HIV-1 gene products are essential elements to the development and design of an effective vaccine. Ideally, both humoral and cellular responses will be optimally elicited. It is therefore important to elucidate any factors that might limit the immunogenicity of HIV-1 proteins that are likely to be included in an effective vaccine. Since the HIV-1 exterior envelope glycoprotein gp120 is a major target for neutralizing antibodies, it is a virtual certainty that this gene product will be a component of any vaccine that seeks to elicit neutralizing antibody responses from the host humoral immune system. We report here the testing of several HIV-1 gp120 variants derived from a primary isolate that appears deficient in eliciting immune responses at both the level of CD4+ help and consequently in the generation of high-affinity IgG antibody responses in small animals. Factors limiting an effective immune response include (a) envelope glycoprotein strain variation decreasing functional T-cell help, (b) alteration of the glycosylation patterns of gp120 by expression in different cell types, and (c) the native structure of gp120 itself, which may limit the elicitation of effective T-cell help during natural infection or during parenteral immunization in adjuvant. Such limiting factors and others should be considered in the design and testing of gp120-based immunogens in small animals and possibly in primates as well.

With the human immunodeficiency virus type 1 (HIV-1) epidemic expanding at increasing speed, development of a safe and effective vaccine remains a high priority. One of the most central vaccine platforms considered is plasmid DNA. However, high doses of DNA and several immunizations are typically needed to achieve detectable T-cell responses. In this study, a Semliki Forest virus replicon DNA vaccine designed for human clinical trials, DREP.HIVA, encoding an antigen that is currently being used in human trials in the context of a conventional DNA plasmid, pTHr.HIVA, was generated. It was shown that a single immunization of DREP.HIVA stimulated HIV-1-specific T-cell responses in mice, suggesting that the poor immunogenicity of conventional DNA vaccines may be enhanced by using viral replicon-based plasmid systems. The results presented here support the evaluation of Semliki Forest virus replicon DNA vaccines in non-human primates and in clinical studies.

The elicitation of broadly neutralizing antibodies directed against the human immunodeficiency virus type 1 (HIV-1) envelope glycoproteins, gp120 and gp41, remains a major challenge. Attempts to utilize monomeric gp120 as an immunogen to elicit high titers of neutralizing antibodies have been disappointing. Envelope glycoprotein constructs that better reflect the trimeric structure of the functional envelope spike have exhibited improved immunogenicity compared with monomeric gp120. We have described soluble gp140 ectodomain constructs with a heterologous trimerization motif; these have previously been shown to elicit antibodies in mice that were able to neutralize a number of HIV-1 isolates, among them primary isolate viruses. Recently, solid-phase proteoliposomes retaining the envelope glycoproteins as trimeric spikes in a physiologic membrane setting have been described. Here, we compare the immunogenic properties of these two trimeric envelope glycoprotein formulations and monomeric gp120 in rabbits. Both trimeric envelope glycoprotein preparations generated neutralizing antibodies more effectively than gp120. In contrast to monomeric gp120, the trimeric envelope glycoproteins elicited neutralizing antibodies with some breadth of neutralization. Furthermore, repeated boosting with the soluble trimeric formulations resulted in an increase in potency that allowed neutralization of a subset of neutralization-resistant HIV-1 primary isolates. We demonstrate that the neutralization is concentration-dependent, is mediated by serum IgG and that the major portion of the neutralizing activity is not directed against the gp120 V3 loop. Thus, mimics of the trimeric envelope glycoprotein spike described here elicit HIV-1-neutralizing antibodies that could contribute to a protective immune response and provide platforms for further modifications to improve the efficiency of this process.

The conserved membrane-proximal external region (MPER) of human immunodeficiency virus type 1 (HIV-1) gp41 is a target of two broadly neutralizing human monoclonal antibodies, 2F5 and 4E10, and is an important lead for vaccine design. However, immunogens that bear MPER epitopes so far have not elicited neutralizing antibodies in laboratory animals. One explanation is that the immunogens fail to recreate the proper molecular environment in which the epitopes of 2F5 and 4E10 are presented on the virus. To explore this molecular environment, we used alanine-scanning mutagenesis across residues 660 to 680 in the MPER of a pseudotyped variant of HIV-1(JR-FL), designated HIV-1(JR2), and examined the ability of 2F5 and 4E10 to neutralize the Ala mutant viruses. The results show that the only changes to produce neutralization resistance to 2F5 occurred in residue D, K, or W of the core epitope (LELDKWANL). Likewise, 4E10 resistance arose by replacing one of three residues; two (W and F) were in the core epitope, and one (W) was seven residues C-terminal to these two (NWFDISNWLW). Importantly, no single substitution resulted in resistance of virus to both 2F5 and 4E10. Surprisingly, 8 out of 21 MPER Ala mutants were more sensitive than the parental pseudovirus to 2F5 and/or 4E10. At most, only small differences in neutralization sensitivity to anti-gp120 monoclonal antibody b12 and peptide T20 were observed with the MPER Ala mutant pseudoviruses. These data suggest that MPER substitutions can act locally and enhance the neutralizing activity of antibodies to this region and imply a distinct role of the MPER of gp41 during HIV-1 envelope-mediated fusion. Neutralization experiments showing synergy between and T20 and 4E10 against HIV-1 are also presented. The data presented may aid in the design of antigens that better present the MPER of gp41 to the immune system.