A number of Phase 3 clinical trials showed lack of efficacy (2–4), with the one exception of the RV144 trial that showed a 31.2% reduction in the risk of HIV acquisition among the vaccinees, compared to individuals given placebo (5). Most vaccine strategies involving HIV envelope immunogens focused on gp120, gp140, or gp160 and did not include analyses of mucosal immune responses in trials performed in nonhuman primate (NHP) models or humans. Notable exceptions include studies performed by the team of Robert-Guroff (6, 7) who tested mucosal delivery of vaccine antigens through either the intranasal or intratracheal routes [reviewed in (8)].
Furthermore, subunit vaccine administration has often involved a single parenteral route (9–11) or sometimes by single mucosal administration (12, 13), but rarely involved combined mucosal and intramuscular (i.m.) immunizations as was done with virosomal vaccines (14, 15). Our team and others have postulated that an effective HIV/AIDS vaccine must be capable of eliciting both systemic and mucosal immune protection for maximal protection of different mucosal portals of entry.