"Extraordinary Journey": Scientists Appraise 20-Year War Against AIDS

The quest for knowledge about HIV has been an "extraordinary journey," Dr. Anthony Fauci told scientists Monday at the International AIDS Society Conference on HIV Pathogenesis and Treatment in Paris. In his keynote speech, Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases and a top AIDS authority, recalled how the odyssey began in 1981 when previously healthy gay men in New York and California began dying of opportunistic diseases, their immune systems destroyed. Within months, scientists learned that the mystery disease was already claiming lives in sub-Saharan Africa.

The 1983 discovery that HIV causes AIDS opened the way for a test for the virus; this was vital for devising prevention strategies and for sequencing the agent, thus exposing its workings at the molecular level, Fauci said.

The mid-1980s introduction of the first generation of HIV drugs was followed, a decade later, by highly active antiretroviral therapy, which has helped turn HIV/AIDS in the developed world from a mortal illness to a manageable disease. Now a third generation of drugs, fusion inhibitors, is targeting the virus at a different part of the infection cycle.

"We probably know more about HIV pathogenesis than we do about any viral disease pathogenesis, but there are some important gaps in our knowledge..." Fauci told a press conference.

Noting that there has never been a documented case of a human whose immune system cleared the virus, Fauci said there are two main reasons why HIV has outwitted attempts to destroy it with drugs or prevent infection with a vaccine. The first is the virus' ability to enter an immune cell and integrate with its genome, essentially shielding itself from surveillance. The other is "its extraordinary capability of mutating" -- making it a moving target for vaccine engineers, Fauci said.

The meeting, which began Sunday, is this year's largest AIDS conference.