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Although treatment regimens combined have transformed the outlook for people living with HIV, a vaccine or effective preventive treatment remains elusive.
Progress on both fronts was reported at the International Society's HIV / AIDS Conference (IAS 2019) this week in Mexico City, as well as numerous studies on antiretroviral therapy to control the virus and prevent its spread. transmission.
Regarding the preventative vaccine, Johnson & Johnson has announced new Phase 1/2 data with its "mosaic" vaccine, based on genes from various HIV-1 subtypes found around the world for the purpose. to create a universal vaccine.
Results from the new ASCENT study showed that adding another component to the badtail – a bivalent soluble protein (gp140) – enhanced the extent of immune responses to a wide range of HIV subtypes, bringing the project closer together. This combination makes it possible to both meet the challenge of the genetic diversity of HIV and improve its effectiveness.
The tendency to mutate the virus means that conventional approaches to vaccine design have been largely ineffective, with at least four previous vaccine candidates failing in the final phase trials. At the same time, those still in development are generally limited in their effectiveness and target strains from certain parts of the world.
The addition of the fourth component improved immune responses to Clade B, the predominant HIV subtype in the Americas, Western Europe and Australasia, without affecting its potency against Clade C, which prevails in southern Africa, in the Horn of Africa and India.
The data will support the upcoming launch of Mosaico, the first phase 3 study for this treatment regimen, to be conducted on three continents, said Hanneke Schuitemaker, head of viral vaccine discovery and translational medicine at the unit. Janssen Pharmaceutical J & J.
Janssen has already tested other badtails in the APPROACH and TRAVERSE Phase 1/2 trials, which led to the selection of a four-component injection that was tested in the Imbokodo Phase 3 study. should be read in 2021.
Another phase 3 clinical trial on HIV vaccine is also underway. It uses a modified version of Sanofi Pasteur's ALVAC-HIV "Thai combination" and GlaxoSmithKline's dual-valued givaxente gp120 / MF59, with a modest efficiency of 31%.
There is still much work to be done to extend the benefits of drug treatment to people around the world, and vaccines could make a vital contribution to HIV control in low-income countries. In 2017, 1.8 million people were newly infected with HIV and nearly one million people died of AIDS, according to UNAIDS figures.
Eliminate the HIV reservoir
The main reason that drug treatment for HIV can control infection, but not eliminate it, is that the virus can hide in reservoirs in the blood, lymph, and other tissues that protect it from exposure. antiretrovirals.
In 2019, Gilead Sciences published the results of two studies of its toll-type receptor 7 (TLR7) agonists, vesatolimod (GS-9620) and GS-986, adding that: it was proven that they could induce immune activation and potentially lead to viral remission. part of the combined regimens. Previous studies on monkeys have shown that some animals were able to maintain viral suppression after stopping treatment.
At the same time, Merck & Co / MSD presented the preliminary results of a new drug against HIV – islatravir (MK-8591) – which, in its opinion, could offer a year of life. anti-HIV activity from a single implant, instead of requiring a daily dosage similar to that of current treatment regimens.
Merck believes that his promise is in pre-exposure prophylaxis, that is, people at high risk of acquiring HIV, for example if they have a relationship with someone who has the virus.
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