Journal Article

Potential Future Impact of a Partially Effective HIV Vaccine in a Southern African Setting

Nakagawa, Fumiyo, Lundgren, Jens D., Van Effelterre, Thierry, Phillips, Andrew N., Ford, Deborah, Roman, François, Cambiano, Valentina, Roset-Bahmanyar, Edith

2014

Overview

It is important for public health and within the HIV vaccine development field to understand the potential population level impact of an HIV vaccine of partial efficacy--both in preventing infection and in reducing viral load in vaccinated individuals who become infected--in the context of a realistic future implementation scenario in resource limited settings. An individual level model of HIV transmission, progression and the effect of antiretroviral therapy was used to predict the outcome to 2060 of introduction in 2025 of a partially effective vaccine with various combinations of efficacy characteristics, in the context of continued ART roll-out in southern Africa. In the context of our base case epidemic (in 2015 HIV prevalence 28% and incidence 1.7 per 100 person years), a vaccine with only 30% preventative efficacy could make a substantial difference in the rate with which HIV incidence declines; the impact on incidence in relative terms is projected to increase over time, with a projected 67% lower HIV incidence in 2060 compared with no vaccine introduction. The projected mean decline in the general adult population death rate 2040-2060 is 11%. A vaccine with no prevention efficacy but which reduces viral load by 1 log is predicted to result in a modest (14%) reduction in HIV incidence and an 8% reduction in death rate in the general adult population (mean 2040-2060). These effects were broadly similar in multivariable uncertainty analysis. Introduction of a partially effective preventive HIV vaccine would make a substantial long-term impact on HIV epidemics in southern Africa, in addition to the effects of ART. Development of an HIV vaccine, even of relatively low apparent efficacy at the individual level, remains a critical global public health goal.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / Africa, Southern - epidemiology / Age / AIDS / AIDS vaccines / AIDS Vaccines - administration & dosage / AIDS Vaccines - biosynthesis / AIDS Vaccines - immunology / Analysis / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biology and Life Sciences / Development and progression / Disease transmission / Drug resistance / Drug therapy / Effectiveness / Epidemics / Female / Health aspects / Highly active antiretroviral therapy / HIV / HIV - immunology / HIV Infections - epidemiology / HIV Infections - immunology / HIV Infections - prevention & control / HIV Infections - virology / Human immunodeficiency virus / Humans / Immunization / Immunization Programs / Incidence / Infection / Infections / Male / Medical diagnosis / Medicine and Health Sciences / Models, Statistical / Mortality / Population / Population decline / Prevalence / Prognosis / Public health / Reduction / Short term / Trends / Uncertainty analysis / Vaccination / Vaccine development / Vaccines / Viral Load - drug effects