Abstract
Although the development of an effective HIVβ1 vaccine has proved very challenging for more than two decades, it remains the best hope to control the HIV pandemic. Since Brazil has particular epidemiological features, as well as adequate policies and infrastructure, the country has been an interesting site for HIV vaccine trials. Since 1995, eight trials were performed in Brazil enrolling over 2000 subjects. Peptide vaccine candidates were initially designed to elicit neutralising antibodies as an attempt to provide sterilising immunity against HIVβ1. This strategy, however, has proved extremely difficult, and candidates were poorly immunogenic. Therefore, the next vaccine candidates focused mainly on the induction of cell mediated immune responses that would limit AIDS progression and transmission by suppressing viremia. Such candidates were naked DNA or viral vectors in either prophylactic or therapeutic approaches. Even though several candidates were immunogenic, protective immune responses against HIVβ1 remain to be achieved. However, several studies with nonβhuman primates and human elite controllers demonstrate that effective immune responses against HIVβ1 may be elicited, supporting the belief that an HIVβ1 vaccine is possible. Much has been learned, and now the development of an effective HIVβ1 vaccine requires resetting priorities with focus on basic research, considering the merits of neutralising antibodies and CMI, as well as the role of innate immunity on HIVβ1 protection. In this new perspective, largeβscale trials should be replaced by smaller preliminary efficacy studies. Copyright Β© 2009 John Wiley & Sons, Ltd.