Kenneth H. Mayer, Section Editor HIV Vaccines: New Frontiers in Vaccine Development

A human immunodeficiency virus (HIV) vaccine is the most promising and feasible strategy to prevent the events during acute infection that simultaneously set the course of the epidemic in the community and the course of the disease for the individual. Because safety concerns limit the use of live, attenuated HIV and inactivated HIV, a variety of alternate approaches is being investigated. Traditional antibody-mediated approaches using recombinant HIV envelope proteins have shown no efficacy in 2 phase III trials. Current HIV vaccine trials are focusing primarily on cytotoxic T lymphocyte–mediated products that use viral vectors, either alone or as boosts to DNA plasmids that contain viral genes. The most immunogenic of these products appear to be the recombinant adenovirus vector vaccines, 2 of which are now in advanced clinical development. The human immunodeficiency virus (HIV) pandemic is now in its third decade. To date, ∼20 million people have died of AIDS, and ∼14,000 are newly infected with HIV every day. Prevention strategies—including behavioral interventions, an-tibiotic treatment for sexually transmitted diseases other than HIV (such as syphilis), and prescreening of blood products— have failed to control the spread of HIV infection in many populations. Antiretroviral therapies remain woefully inade