Biology Reference
In-Depth Information
New strategies are being designed for patients with chronic infection. These
include new immunotherapeutic approaches, such as HIV vaccination or cyto-
kine therapy (Chun et al., 1999; Davey et al., 2000), which might enhance virus-
speci®c immunity, allowing the control of any viruses released from the latent
reservoir, and the use of structured treatment interruptions, which, besides
possibly boosting the immune system may decrease the overall exposure to
antiretroviral drugs.
The hope is that stimulation of HIV-speci®c responses may increase the
number of patients that achieve undetectable RNA levels, delay the emergence
of resistance, forgive less than perfect adherence, prolong duration and, possi-
bly, allow discontinuation of treatment (because we may turn patients into
``long-term nonprogressors'').
CONCLUSION
Although the global solution to the further spread of HIV may still rest on the
discovery of an e¨ective prophylactic vaccine, the availabilityÐat least in the
western worldÐof improved antiretroviral drugs together with the develop-
ment of innovative treatment strategies, raises the hope of changing HIV dis-
ease into a chronic condition with no or little impact on the life span of the
many already infected. Challenges to more successful HIV therapy include im-
proving adherence to drugs by enhancing their pharmacological and toxicity
pro®les, containing the development of drug-resistance, and developing e¨ec-
tive immune interventions. In fact, with HIV eradication not at the immediate
horizon, the evidence of a speci®c and e¨ective cellular immune response
against HIV point to the potential advantages of an immune manipulation.
The fact that the impressive therapeutic gains in the management of HIV
disease bene®t only 10% of the HIV-infected population in the world highlights
the need to develop strategies to increase access to care and treatment for the
remaining 90%. On a global scale, the main challenge will be to make broadly
available prevention methods, life-saving treatments, and the results of scienti®c
breakthroughs in care, on an equitable and a¨ordable basis, to all HIV-infected
persons throughout the continents. Actions in this direction should clearly
foster a sharp decrease of price of antiretroviral drugs in developing countries,
but also be based on the overall strenghtening of local health systems, on
building the infrastructures, on education and training of healthcare providers,
and, ®nally, on the reorientation of basic and clinical research to address issues
of antiretroviral treatment in countries with limited ®nancial resources.
Acknowledgments. The author gratefully acknowledges the thoughtful inputs
of Diane Havlir, Professor of Medicine, University of California at San Diego,
Scott Hammer, Professor of Medicine, Columbia University, New York, NY,
and Joep Lange, Professor of Medicine, University of Amsterdam.
