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IN THEIR POLICY FORUM "HIV VACCINE TRIAL justified" (13 Feb., p. 961), J. G. McNeil and colleagues neglect to address one key concern regarding the recently initiated phase III prime-boost HIV vaccine trial. Although the boost component, AIDSVAX B/E, has previously failed to demonstrate protective efficacy ("A sound rationale needed for phase III HIV-1 vaccine trials," D. R. Burton et al., Policy Forum, 16 Jan., p. 316), the study as currently designed cannot show whether the boost improves or reduces the protective efficacy that might be offered by the ALVAC vCP1521 vector being used as the prime component.
Unlike AIDSVAX, ALVAC has never been evaluated in an efficacy trial. We believe that a definitive evaluation of whether ALVAC can offer protection against HIV infection or ameliorate postinfection viral load is preferable to the single-arm prime-boost versus placebo trial, as it is presently designed, which cannot address these questions because of the potentially...