Uhm the HSV vaccine pipeline seems to have changed. Excision had clinical trials scheduled for 2021 a few years back, if I'm not mistaken. There are about 4 billion people infected with HSV worldwide*. Excision could prioritize and deliver the HSV vaccine and have the company well-funded for other causes.
I recently found a great subreddit with a table in their stickied thread about the latest research on HSV cures and treatments. There are several cures under testing and we may see the first people cured of HSV in 2024:
Clinical trials are expensive so unless you're massively well funded (like Moderna and BioNTech are at the moment, and basically nobody else in that space) you have to prioritize for whichever is the most promising based on prelim data. This is a problem trivially solved with money, but for some reason all the promising biotech developers are massively underfunded compared to branches such as killing people or selling advertising.
hsv may have a broader market, but there is clearly a greater social benefit and urgency to new hiv treatments. hsv infection is essentially a minor annoyance compared to hiv which can be life-changing and lethal.
HSV is, iirc, one of the most significant causes of serious conditions like viral encephalitis. I wouldn’t be surprised if the net impact were similar to or greater than an HIV cure, considering that about 5,000x more people have HSV than HIV (order of magnitude estimate from a quick look at some stats I found online). Of course, the PR of an HIV cure is much better.
hsv encephalitis incidence is like 2 per million which is absolutely incomparable to hiv infection which has rates as much as 1 in 5 in some high risk populations and 4930 per million globally. the net impact of a new effective hiv treatment is indisputably more significant.
> hsv encephalitis incidence is like 2 per million
This can’t possibly be correct. It’s the most commonly diagnosed etiology for viral encephalitis, which definitely occurs more than a single digit per million. It’s also going to be underdiagnosed because the diagnostics are bad (fewer than half of encephalitis cases are assigned an etiology). I see several sources saying in the range of 2-4,000 confirmed HSV encephalitis cases per year in the US (which are usually extremely severe, leading to brain damage or death), compared to 5,500 “HIV-related” deaths per year in the US according to the CDC. So at the very least they seem similar in magnitude.
HIV is very manageable with drugs, and life expectations are very high. Whilst the disease is horrible, and we should be seeking a cure, its manageable. HSV is emerging as one of the biggest contributors to dementia. That is itself a disease that kills - just over a longer time span. Unfortunately for HSV there is little long term strategy for management that can address this issue. The *ciclovir drugs primarily target viral shedding, and not the rest of the infection cycle.
It takes non trivial logistical efforts to deliver HIV drugs to people. Think folks living in slums in south africa, homeless drug users in the USA, etc.
* https://www.who.int/news-room/fact-sheets/detail/herpes-simp...