The media circus that followed Dr Robert Gallo yesterday down the aisle of hall 1.2 suggested we were in for something big. Gallo’s presentation certainly turned out to be provocative. Studies from his team suggest entry inhibitors should be a target for vaccines, rather than the usual reliance on the production of neutralising antibodies derived from the use of sole “envelope” vaccines.

Gallo proposed that entry inhibitor vaccines, by blocking the entry of HIV into the CD4 cell, could be active against a much higher number of HIV mutations, both as prevention, and as therapy. Taken together with one of his opening statements, that the “days of protease inhibitors are numbered because of toxicity problems,” he was clearly trying to forge a new path through the complexities of HIV treatments.

It’s clear that vaccines are now attracting a similar “buzz” to that of combination therapy at the 1996 Vancouver conference. Lawrence Corey’s plenary presentation called for a renewed focus on vaccine development. Sessions and press conferences during the week have promoted access to vaccines as a human right, and the notion of a “vaccine advocacy” movement is beginning to be heard in daily discourse, and not just at the fringes, but in mainstream events and satellite meetings.

The optimism of a positive outcome from the Thailand phase III vaccine trials hinted at yesterday adds impetus to the notion that we may be on the brink finding the final piece of the jigsaw in HIV prevention.

This would be hasty. The myriad of vaccine studies presented here suggest clinical science is still seeking what “works” in this area.

Science seems to promise much, be it treatment, or successful vaccines. In reality, however, we should remember that though clinical research may result in products that are of proven benefit, getting treatment to people who really need help is much more complicated.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team