Vaksin Berbasis Messenger Ribonucleic Acid (mRNA) untuk Pencegahan Human Immunodeficiency Virus (HIV): Perkembangan Teknologi dan Bukti Klinis Terkini

Abstract

Background: Human Immunodeficiency Virus (HIV) remains a major global public health challenge. According to the World Health Organization (WHO), in 2025, approximately 41 million people were living with HIV, with an estimated 570,000 deaths attributable to HIV-related causes and 1.2 million new HIV infections. These figures underscore the importance of effective HIV prevention strategies. Messenger ribonucleic acid (mRNA)-based vaccines represent a promising platform for HIV prevention because they enable flexible delivery and expression of HIV immunogens.

Objective: To evaluate the development and potential of mRNA-based vaccines for HIV prevention. Methods: A narrative literature review was conducted using the Cochrane Library, Europe PMC, PubMed, ScienceDirect, Semantic Scholar, SpringerLink, Wiley Online Library, and Google Scholar for publications from 2021 to 2026. A total of 17 peer-reviewed articles were included and narratively synthesized.

Results: Preclinical studies and phase I trials demonstrated that mRNA-LNP vaccines can induce HIV-specific humoral and cellular immune responses. In macaques, one candidate reduced the risk of heterologous SHIV infection by 79% per exposure. In humans, IAVI G002 and G003 demonstrated activation and early maturation of VRC01-class bnAb precursors, while HVTN 302 induced autologous tier 2 neutralizing antibodies in 80% of recipients receiving membrane-anchored Env trimers compared with 4% receiving soluble trimers. However, current evidence has not demonstrated that mRNA vaccines can prevent HIV acquisition in humans, induce broad and durable bnAb responses, or provide protection against viral diversity.

Conclusion: mRNA-based HIV vaccines demonstrate biological feasibility and promising early clinical immunogenicity, but their protective efficacy has not yet been established. Further clinical studies are warranted to optimize delivery systems, dosing, durability of immune responses, and long-term safety.

Keyword: antibodies; HIV prevention; immunogenicity; mRNA vaccine

Latar Belakang: Human Immunodeficiency Virus (HIV) masih menjadi masalah kesehatan masyarakat global. Menurut World Health Organization (WHO), pada tahun 2025 diperkirakan terdapat 41 juta orang yang hidup dengan HIV, dengan sekitar 570.000 kematian akibat penyebab terkait HIV dan 1,2 juta infeksi baru. Hal ini menunjukkan pentingnya pencegahan HIV. Vaksin berbasis messenger ribonucleic acid (mRNA) merupakan salah satu platform yang berpotensi dikembangkan untuk pencegahan HIV karena memungkinkan penghantaran dan ekspresi imunogen secara fleksibel.

Tujuan: Mengevaluasi perkembangan dan potensi vaksin berbasis mRNA untuk pencegahan HIV.

Metode: Penelitian ini menggunakan narrative literature review. Pencarian literatur dilakukan melalui Cochrane Library, Europe PMC, PubMed, ScienceDirect, Semantic Scholar, SpringerLink, Wiley Online Library, dan Google Scholar terhadap publikasi tahun 2021–2026. Sebanyak 17 artikel ilmiah peer-reviewed yang memenuhi kriteria inklusi disintesis secara naratif.

Hasil: Penelitian praklinis dan uji fase I menunjukkan bahwa mRNA-LNP dapat menginduksi respons imun humoral dan seluler spesifik HIV. Pada kera, salah satu kandidat menurunkan risiko infeksi SHIV heterolog sebesar 79% per pajanan. Pada manusia, IAVI G002 dan G003 menunjukkan aktivasi serta pematangan awal prekursor bnAb kelas VRC01, sedangkan HVTN 302 menghasilkan antibodi penetral tier 2 autolog pada 80% penerima trimer Env membrane-anchored dibandingkan 4% pada trimer terlarut. Namun, bukti yang tersedia belum menunjukkan kemampuan vaksin mRNA dalam mencegah akuisisi HIV pada manusia, menghasilkan respons bnAb yang luas dan persisten, atau memberikan perlindungan terhadap keragaman virus.

Kesimpulan: Vaksin HIV berbasis mRNA menunjukkan kelayakan biologis dan imunogenisitas klinis awal, tetapi efikasi protektifnya belum terbukti. Diperlukan uji klinis lebih lanjut untuk mengoptimalkan sistem penghantaran, dosis, durabilitas, dan keamanan jangka panjang.

Kata kunci: antibodi; pencegahan HIV; respons imun; vaksin mRNA.