Paul Volberding, MD Comments On the Future of HIV/AIDS Research
Paul Volberding, MD: Vice Chair of Medicine at the University of California, San Francisco, Chief of the Medical Service at the San Francisco VA Medical Center
HIV care continues, in mid-2001, to benefit from the availability of several potent drug regimens. Despite limitations in convenience and toxicity, and even though many patients have accumulated increasing resistance to therapy, they are still living free of the devastating opportunistic infections, cancers and wasting illnesses that were the predictable result of infection until 1996. The striking clinical benefit of HIV therapy and the very low mortality from HIV in most parts of the US will wane somewhat over the next few years. There is good data that CD4 cell counts will eventually decline in the face of ongoing HIV replication, and there is no reason to think that "AIDS" won't again appear if one's CD4 cells remain severely depressed for prolonged times. But there is also reason for optimism. New drugs and drug classes are far enough along in development that should have less cross resistance with today's approved agents, and we may eventually learn enough about the nature of immune control of HIV infection to develop therapies that slow or even reverse the immune damage caused by HIV infection.
The next several years will, in the developed world, focus on incremental advances in dealing with resistance and in managing the side effects of current drugs, and we will see several new drugs approved. It is impossible to imagine sufficient progress in vaccines to lead to approval of any protective vaccine soon, but research in this field will be the target of substantial investment and much new knowledge will certainly follow. Our focus will continue to shift to include the developing countries where the epidemic remains uncontrolled. HIV will be an effective model and probe to see how much true commitment the developed world has to distribute the lifesaving results of a largely public investment in new treatments and vaccines for diseases easily controlled for those with adequate resources. Hopefully, we will live to see the day when all have the hope that comes with health.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.