Twenty-Five Years of AIDS: Where Are We Now?

http://www.medscape.com/viewarticle/546111

Posted 10/27/2006

Mark A. Wainberg, PhD

Twenty-five years of AIDS: Where are we now? The 16th International Conference on AIDS highlighted enormous progress that has been observed since the first cases were reported 25 years ago in MMWR.

Our greatest successes in the management of HIV infection are now 10 years old. Highly active antiretroviral therapy, or HAART, has transformed HIV infection into a chronic, manageable condition in the affluent countries in which these drugs are widely available. In contrast, over 20 million HIV-infected individuals in Africa alone will die unless they obtain access to these lifesaving medications.^[1]

At the world's largest conference on AIDS, attention also was focused on scientific advances that provide hope for the future. First, clinical data were presented on 2 new classes of antiretroviral drugs, viral integrase inhibitors^[2,3] and entry inhibitors,^[4,5] which both show excellent activity against all strains of HIV, including those that are resistant to all currently approved drugs. One of these, an integrase inhibitor, caused viral loads to plummet more sharply than has been seen with any antiretroviral drug studied to date. The entry inhibitors act by antagonizing cellular proteins. Since the latter compounds target a cellular component, rather than the virus directly, there is hope that resistance to these drugs will not easily develop.

Another area of progress is the development of rapid saliva-based diagnostic assays to detect HIV infection. At present, the turnaround time for an antibody test is 3 weeks, and many people do not return to the clinic to obtain results. Soon, patients will receive antibody results while waiting in a doctor's office, which obviates the tortuous 3-week waiting period of older tests. This work may also lead to a public health benefit, since individuals at high risk of contracting and spreading HIV are known to reduce risk behavior if they know they are infected.^[6,7]

Thus, the 16th International Conference on AIDS delivered good news in regard to both HIV therapeutics and diagnostics. We hope that political action will help ensure that these advances become available to people throughout the world.

That's my opinion. I'm Dr. Mark Wainberg. I was the Co-Chairman of the 16th International Conference on AIDS, and I am a Professor of Medicine and Microbiology and Director of the McGill University AIDS Center.

Mark A. Wainberg, mark.wainberg@mcgill.ca