Jill Cadman Comments On the Future of HIV/AIDS Research

Jill Cadman: Long-time HIV treatment advocate and educator, currently editing the PositiveWords.com HIV Newsletter website

Scientific research has brought us to where we are today in our understanding of so many diseases. HIV research in particular seems to have progressed both amazingly fast and agonizingly slow at the same time. We have come so far, but have lost so many along the way. In haste, we have sometimes jumped to wrong conclusions, and there are those who have suffered by following approaches that were considered the standard of care at the time, but have since been discredited or revised. Also, despite regulations and controls, clinical trial results are subject to misinterpretation and bias and must be evaluated with a critical eye.

Having said this, thousands of people are alive and well because of the hard work and dedication of researchers. HIV-positive women have been able to have healthy children and can look forward to seeing them grow up. Many significant questions have been answered and numerous important drugs and diagnostic tests are available to the public in economies that can afford them. But in many ways, the hard work has only just begun. The really tough areas, like salvage therapy, prevention and vaccine research, are lagging behind.

At this point in time, those who are newly diagnosed or stable have many options, albeit with a high cost to pay in terms of side effects. While I would like to see more progress in the area of side effect management (both alternative and mainstream) and the development of less toxic new drugs or combinations of drugs, I feel that people who have run through all the antiviral drugs should be addressed first. Those in need of salvage therapy are basically back to the pre-AZT era. They have no treatment options left and are vulnerable to opportunistic infections. Creative approaches to salvage therapy must receive more of a concerted effort.

The other priority has to be in the area of prevention. There is such a strong link between substance use and HIV infection that behavioral research into addiction prevention and control is very important. Finally, true behavior change is so difficult that I think the most important goal has to be a preventative vaccine to stop infection in the first place.