katharine kripke, ph.d. assistant director, vaccine research program, division of aids, niaid aids...
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Katharine Kripke, Ph.D.
Assistant Director, Vaccine Research Program, Division of AIDS, NIAID
AIDS Vaccine 2011 Journalist Training ProgramSeptember 11, 2011
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Scaling up treatment is essential
Scaling up other prevention interventions is essential
Even with ART decreasing transmission by 96%, people are most infectious in the first weeks after infection, when they are least likely to be on ART
Circumcision is ~60% effective and only protects ♂
Other prevention interventions (condoms, needle exchange, microbicides, PrEP) are highly dependent on adherence
A highly effective vaccine would be less of a burden on individuals than lifelong treatment or behaviorally dependent prevention
Even a partially effective vaccine would be cost-effective
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True or false?
Participants might get HIV from the vaccine being tested.
There is already an effective HIV vaccine, but it’s being deliberately withheld.
Vaccines are intended to cure people with HIV.If someone volunteers in an HIV vaccine trial, it
means they have HIV.Researchers test HIV vaccines by administering the
vaccine and then exposing the participants to the virus.
Researchers try to get participants to engage in high-risk behavior so that they get exposed to the virus.
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What is an ideal vaccine?
Effective (>90%) Protects against different subtypes of HIV
• One vaccine for all subtypes, or different vaccines tailored to different subtypes?
Protects against different routes of infection (vaginal, anal, blood)
Can be manufactured to scale Protects diverse people (sex, geography, genetics,
behavior) As few vaccinations per person as possible Affordable Acceptable
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DiscoveryPreclinical Research &
Development
Clinical Research
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Vaccine trial process
Preclinical Phase I Phase II Phase III
Participants
Goals
Animals
20-100 people 100-200
peoplethousands of people
•Produce an immune response?•Protect after viral challenge?
•Safe?•Immune response?
•Best dose?•Safe?•Magnitude/ types of immune response?
•Does it work?
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HIV-negative participants HIV-negative participants
vaccine
placebo
Risk-reduction counseling
Risk-reduction counseling
Vaccine is 75%
effective
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Research Safety & Ethics
Government regulation (FDA in US) Protocols Independent expert review/oversight Community Advisory Boards Informed consent process
• Consent form• Explanation of risks• Free to leave study
Reporting results
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Participants for HIV vaccine research
Participants should represent different:• Sexes• Races/Ethnicities• Socioeconomic
backgrounds• Potential routes of
transmission• Environmental
backgrounds• HIV risk levels
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Risks of Participation
Like most vaccines, the HIV vaccines used in clinical trials may cause side effects, such as:• Soreness at the injection site• Low-grade fever• Body aches
Side effects tend to go away quickly on their own
No long term side effects have been identified in HIV vaccines tested to date
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Risk behavior in trials
Participants in clinical trials are continually counseled on how to reduce the risk of being exposed to HIV infection
No evidence that participation in HIV vaccine research leads individuals to engage in behaviors that increase their HIV risk
Data from several trials completed to date shows that risk behaviors usually decline overall, particularly during the vaccination period when study visits are more frequent
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Vaccine-induced seropositivity
HIV vaccines are designed to provoke immune responses – this includes antibody production
Standard tests for HIV detect antibodies, not virus
Study participants who receive HIV vaccines will often test positive (seropositive) on these standard tests but it doesn’t mean they are HIV-infected
Frequency varies by vaccine—can be >80%
Durability: Potentially >10 years
We refer to this as Vaccine-Induced SeroPositivity, or VISP
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Results of Phase III Thai Trial (RV144)
HVTN 505 enrollment
begins
1980 1990 2000 2010
First HIV vaccine
trial opens Phase II Step and Phambili studies halted
VaxGen candidate fails
in Phase III trials
HIV identified
?
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True or false?
Participants might get HIV from the vaccine being tested.
There is already an effective HIV vaccine, but it’s being deliberately withheld.
Vaccines are intended to cure people with HIV.If someone volunteers in an HIV vaccine trial, it
means they have HIV.Researchers test HIV vaccines by administering the
vaccine and then exposing the participants to the virus.
Researchers try to get participants to engage in high-risk behavior so that they get exposed to the virus.
![Page 17: Katharine Kripke, Ph.D. Assistant Director, Vaccine Research Program, Division of AIDS, NIAID AIDS Vaccine 2011 Journalist Training Program September 11,](https://reader036.vdocuments.net/reader036/viewer/2022062422/56649ec05503460f94bcb2c6/html5/thumbnails/17.jpg)
How people can help find an HIV vaccine:
Educate themselves and others about HIV vaccine research – visit http://bethegeneration.nih.gov.
Talk to friends and family members about HIV vaccine research.
Talk about HIV prevention.
Volunteer for an HIV/AIDS vaccine trial.
Be supportive of trial volunteers.
Visit www.hvtn.org to find a local vaccine trial site & participate in a Community Advisory Board.
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BeTheGeneration.NIH.gov
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3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
♦
♦
♦
♦
Enrollment Follow-up
ST
EP
RV
144
HV
TN
503
PA
VE
100
2003
Anticipated Data Availability
HVTN 503
PAVE 100
RV 144
Merck 023/HVTN 502 (STEP)
2004 2005 2006 20112007 2008 2009 2010
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3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
HVTN 503
PAVE 100
Enrollment Follow-up ST
EP
RV
144
HV
TN
503
PA
VE
100
RV 144
Merck 023/HVTN 502 (STEP)
HVTN 505
20112007 2008 2009 20102003 2004 2005 2006