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DEBBIE ELLIOTT, host:

And we note another anniversary now. Ten years ago yesterday, in a commencement address, then President Bill Clinton set the goal of developing an HIV vaccine in a decade.

President BILL CLINTON: And it cannot come a day too soon. If America commits to find an AIDS vaccine and we enlist others in our cause, we will do it.

ELLIOTT: Today, doctors still cannot immunize people against HIV infection, and researchers are beginning to shift their understanding of what a possible vaccine might look like.

To better understand the current state of HIV vaccine research, we turn to Dr. Anthony Fauci. He is director of the National Institute of Allergy and Infectious Diseases. That's the division of the National Institutes of Health responsible for AIDS research.

Welcome to the program, Dr. Fauci.

Dr. ANTHONY FAUCI (Director, National Institute of Allergy and Infectious Diseases): Thank you very much. It's nice to be here.

ELLIOTT: It's been 10 years since President Clinton announced his goal. But it's actually been 20 years since the first HIV vaccine tests were conducted. Why has it been so difficult to devise an HIV vaccine - one that completely prevents infection?

Dr. FAUCI: The reason is that the virus itself is really very unique in how it interacts with the body's immune system. Generally, when you make vaccines to common often very serious illnesses like polio or smallpox or measles, what you do is you mimic with your vaccine the way the body naturally responds to these viruses because at the end of the day, the bodies does, generally, very well even though people get sick and some people die. So you design a vaccine to induce the same kind of immune response that the body would do against the natural infection.

Unfortunately, with HIV, that's not the case. Because HIV is not handled very well, ultimately, by the body at all, in fact, it's virtually the only infection we know where the body is just incapable of eradicating it after the infection gets established. So we have to do something a little bit different.

And that's what the scientists have been talking about lately is what we call getting away from the classical paradigm of developing a vaccine and doing something that would aim at a little different goal, perhaps, not necessarily preventing initial infection but actually blocking the progression of disease and keeping the level of virus low so that people can go for extended periods of time without therapy and perhaps even decrease the possibility that they'll infect others. So that's a whole new different way because HIV is really a very different kind of a virus.

ELLIOTT: We don't hear as much about the search for an AIDS vaccine as we used to. But we do hear a lot about the success of new drugs that allow people with HIV to live longer lives. Has that at all taken pressure off researchers who were looking for a vaccine?

Dr. FAUCI: No, not at all. You haven't heard about it because they haven't been the kinds of major breakthroughs that have occurred with therapy, where you actually get a combination of good drugs and you could completely transform the lives of people who are HIV infected. We know now the results are really astounding. And even better drugs are coming along. What we're seeing with the HIV vaccine research, it's steadily progressing clearly in the right direction, but not any big breakthrough that's transforming that would capture the attention or the imagination of the general public.

ELLIOTT: When we talk about a vaccine that is not in the classic sense of what we all think of when we go get our children their immunization shot, what are we talking about? How would this affect people and who would you give it to?

Dr. FAUCI: Well, you would give it to the same people who are in relatively high-risk category. So that would not change whether you have a classical vaccine or what we're calling the non-classical. Now, the first step towards success may be that you actually vaccinate someone may not necessarily prevent them getting infected but you would prevent the inexpiable development of serious disease, not necessarily eliminate it but delay it.

Importantly, the vaccine might in fact blunt the level of virus so that when people are infected, they don't have high levels of virus, which make it more likely that they would infect others. We know very clearly that there is a direct relationship between the level of virus circulating in person's body and the probability of their infecting someone else. It's not the homerun you want, but it's the first step towards where we want to be.

ELLIOTT: Isn't there a bit of a risk there that if this type of a vaccine were developed and it only offers a limited protection, that that could give people some sort of false sense of security?

Dr. FAUCI: Yeah. That's certainly is, and that's why a major part of the program of this type of development of the vaccine is the education that it cannot be a stand-alone countermeasure. If you get a vaccine like this, it has to be part of a very comprehensive prevention program so that you cannot say I'm vaccinated therefore I'm good to go, I'm free of getting infected. It has to be part of the same kind of preventive measures that you would use even if you were not vaccinated.

ELLIOTT: Are researchers still looking for that silver bullet? Do you think there ever will be a classic vaccine for HIV?

Dr. FAUCI: Undoubtedly, there's no question about it, and we emphasize this whenever we discussed the non-classical approach. This is not a substitute for the trying - for getting the homerun that I talked about.

Research is still gauged at trying to get a vaccine that would completely prevent infection. Do I think we, ultimately, will get a vaccine? I think so. I don't know how many years from now, but that would be that we get the typical, classical vaccine. But I do think we can say there is some cautious optimism that we'd be able to get some effect from a non-classical approach.

ELLIOTT: Dr. Anthony Fauci is director of the National Institute of Allergy and Infectious Diseases. Thank you for speaking with us.

Dr. FAUCI: Thank you. You're quite welcome.

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