title: AIDS vaccines that allow HIV-1 to infect and escape immunologic control: a mathematic analysis of mass vaccination.
abstract: Cytotoxic T lymphocyte (CTL)-based HIV vaccine concepts shown to reduce viremia and postpone disease but not to prevent infection in monkeys are currently in human phase 1 trials. To evaluate the potential efficacy of vaccines that cannot prevent HIV-1 to infect and escape immunologic control, we designed a mathematic model that correlates the level of viremia to both infectiousness and disease progression. We speculate that vaccinees will have a virologic set point and disease progression rates comparable to untreated HIV-1-infected individuals with the best prognosis. Our model (illustrated with R0 = 3) shows that a sexually active population can ultimately be reduced to 26% of its initial size as a result of AIDS-related mortality in the absence of treatment or vaccination. Start of vaccination when HIV-1 prevalence is still low might postpone the peak incidence of infection and the dramatic decline in population size by up to 22 years. In conclusion, CTL-based vaccines that do not prevent HIV-1 infection but do postpone the time to onset of AIDS have considerable potential to curb the spread of HIV-1 and to postpone high AIDS-related mortality on a population level. The number of long-term survivors is substantially increased only when vaccination is initiated early in an AIDS epidemic, however.
authors.affiliation: Institute for Biodiversity and Ecosystem Dynamics, Faculty of Science, University of Amsterdam, The Netherlands.
authors.forename: Marijn
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Bogaards
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Weverling
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Boerlijst
authors.forename: Jaap
authors.initials: J
authors.lastname: Goudsmit
mesh_terms: D016915:AIDS Vaccines / Q000276:immunology*; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology* / Q000401:mortality; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D032541:Mass Vaccination; D008433:Mathematics; D011157:Population Dynamics; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
chemical_list: D016915:AIDS Vaccines