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HIV-1 superinfections: omens for vaccine efficacy?

In the latter part of 2002 and early 2003, there were four published reports of superinfection of HIV-1– infected individuals with a second strain of HIV-1 [1– 4]. This information has been received with both surprise and dismay. While the surprise expressed by some individuals is, in itself, surprising, the dismay appears to be justified because of its negative implications relative to development of an HIV-1 vaccine. If the superinfections occurred in infected individuals with high titers of antiviral antibodies, CD4 and CD8 T-cell responses, and little or no measurable dysfunction of their immune systems, it would imply that the prospects for an efficacious vaccine that could prevent HIV infection or limit dissemination and disease progression were not good. While the former goal is the ideal, albeit unrealistic, one, the latter might be possible.