Garth Rattray

Since 1984 when medical science discovered that the Human Immunodeficiency Virus (HIV) was responsible for the Acquired Immunodeficiency Syn-drome (AIDS), there has been a concerted effort to control the growing epidemic that it caused. We know how to suppress the infection, but we can't cure it.

Combinations of anti-retroviral drugs are used to control HIV and maintain the health of people living with HIV/AIDS (PLWHA) for years. Some (fusion inhibitors) inhibit the virus from entering healthy T-cells (a kind of white blood cell that warns our immune system when we are being invaded by germs), some inhibit HIV from infecting the T-cell (nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors) and others inhibit HIV from producing new copies of itself (protease inhibitors). There's even a new experimental drug (temporarily named MK-0518) from a new class called Integrase inhibitors.

Drugs control the spread

These drugs do not eliminate HIV from our bodies; they only control the spread. Even when they achieve extremely low viral counts, we know that HIV 'hides' in sanctuary sites, such as, the central nervous system, testes and resting T4-lymphocytes and is therefore still a threat and still transmissible.

Worldwide efforts at prevention (counselling re: abstention, single partners and barrier-protected sexual intercourse) have achieved limited success because people don't comply. Twenty-five million persons have died from AIDS since it was first recognised in 1981 and an estimated 40.3 million are currently infected. Jamaica has 6,241 documented AIDS deaths, 25,000 PLWHA and an estimated 15,000 infected persons unaware of their status.

Our best hope for controlling the HIV/AIDS epidemic lies in vaccination. Since 2003, Jamaica has been part of the HIV Vaccine Trials Network (HVTN). It is an international collaboration of scientists and educators searching for an effective and safe HIV vaccine. Its crucial mission is to facilitate the testing of preventive vaccines against HIV/AIDS through several phases of clinical trials of evaluating the safety, efficacy and the ability of experimental vaccines to stimulate immune responses.

HIV/AIDS affects everyone so we need to know if the vaccine will work on all populations. To this end, the HVTN has 27 sites on four continents and the Caribbean including Jamaica, Puerto Rico, Haiti and The Dominican Republic. It has been testing vaccines manufactured by several pharmaceutical companies under the strictest of ethical and safety guidelines which have been developed, scrutinised, approved and monitored by the U.S. Federal Drug Administration, the National Institute of Allergy and Infectious Diseases of the U.S. and the National Institute of Health (an agency of the U.S. Department of Health and Human Services). Here in Jamaica, ethical oversight is through the Advisory Panel on Medico-Legal Affairs of the Ministry of Health and University Hospital of the West Indies/ University of the West Indies/ Faculty of Medical Science (UHWI/UWI/FMS) Ethics Committee.

Vaccines are synthetic

It is impossible to get HIV from any of the vaccines because they are purely synthetic. No part of the virus (live, dead or weakened) is used in making them. The vaccines have already gone past lab testing and even past phase I testing (tests on small numbers of HIV-negative people for safety and immune response). Jamaica is participating in phase II and phase IIb trials. These trials involve hundreds of healthy HIV-negative people between 18-50 years old to determine whether the vaccine prevents HIV infection and is safe in large numbers of people.

People are already volunteering and the vaccine has already been administered. If you want to learn more about the HIV Vaccine Trials or participate, call the Epidemiology Research and Training Unit (ERTU) located on the Compre-hensive Clinic compound at 922-4461 or 922-2513.

Dr Garth A. Rattray is a medical doctor with a family practice.