24 July 2015 vol 349, issue 6246, pages 341-448
Toward an HIV vaccine: A scientific journey
Anthony S. Fauci1,*, Hilary D. Marston2
1Anthony S. Fauci M.D. is the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Bethesda, MD 20892, USA.
2Hilary D. Marston M.D., M.P.H. is a Medical Officer and Policy Advisor for Global Health at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Bethesda, MD 20892, USA.
In the face of a global pandemic, the search for an effective vaccine against the human immunodeficiency virus (HIV) remains an urgent priority. From the first HIV vaccine trials in the 1980s to the present, a tension has existed between the desire to move quickly to clinical trials to stem the spread of the epidemic and the view that research into HIV pathogenesis and host immunity were necessary predicates to and informative of vaccine design. Those advocating the first strategy—an empirical (or inductive) approach—argued that in vitro and animal studies were poorly predictive of the human response to HIV infection and that the only way to gauge vaccine efficacy was to test candidates in humans. Those advocating the second strategy—a theoretical (or deductive) approach—hoped to establish an understanding of the immune response to natural infection and to find ways to recapitulate and enhance that response through vaccination. Today, these approaches are coalescing into concomitant paths toward a safe and effective HIV vaccine.