Short communicationThe feasibility of HIV vaccine efficacy trials among Russian injection drug users
Introduction
There are estimated to be over 13 million injection drug users (IDUs) worldwide, and IDU in many settings are at high risk for HIV-1 acquisition [1]. IDU risks have been the predominant mode of HIV-1 spread in much of the Former Soviet Union and explosive spread of HIV among IDUs was documented through 1998–2001 in several Russian cities [2], [3]. Current estimates are that some 70–90% of HIV infections in the Russian Federation are attributable to injection drug use [4].
There is a growing consensus that a preventive HIV vaccine would be a key component in the global control of HIV spread [5]. Given the epidemiology of HIV in countries such as Russia, where parenteral exposure through IDU is the predominant mode of spread, it may be essential to investigate this route of transmission in HIV vaccine efficacy trials. If vaccine efficacy does differ by route of exposure, HIV vaccine candidates and strategies which have not been evaluated in the context of parenteral transmission could have limited utility in regions where this risk factor accounts for the majority of spread. One efficacy trial has been conducted in IDU, the Thai AIDSVAX trial among Bangkok IDU, but this remains an under-studied research domain. No efficacy trials with later-generation HIV vaccine candidates are currently underway among IDU.
Section snippets
The Russian context
The HIV Prevention Trial Network (HPTN) of the U.S. NIH conducted a multi-site cohort preparedness trial among IDUs in two Chinese cities and in St. Petersburg, Russia. This trial in Russia, which was funded by a grant to the University of North Carolina and the Biomedical Center (BC) in St. Petersburg, enrolled 520 IDUs between March and December of 2002 and followed them through to 2004. This study demonstrated a baseline HIV prevalence of 30% among IDUs and a measured HIV-1 incidence of
Site-specific challenges
There are many challenges in designing an effective HIV vaccine trial, particularly one implemented in a marginalized population such as IDUs. However, there are some challenges that are specific to the Russian context that need to be further explored and overcome before vaccine trials can proceed. UNAIDS has published a comprehensive guidance document outlining the specific ethical considerations when designing preventive HIV vaccine protocols [18]. One of the guidance points specifically
Conclusions
IDU exposure remains a primary driver of the Russian HIV epidemic, and recent incidence data provide little evidence that this epidemic is slowing. Studies of molecular epidemiology of the infecting strains have shown significant homogeneity of subtype A and relatively little increase in genetic diversity over the last 4 years. A preventive HIV vaccine would be an important addition to the arsenal used to prevent HIV transmission. And there are already vaccine candidates in the pipeline both in
Acknowledgements
The authors would like to acknowledge Charles Vitek, lead for the United States Centers for Disease Control activities in Russia for sharing his expertise of HIV vaccines and his insights into the dynamics of the Russian HIV epidemic.
Funding: The source of funding did not play a role in the interpretation of the data, or writing of the manuscript.
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