A better understanding of the dynamics of HIV infection now shows that the virus is able to lie dormant in various reservoirs such as genital secretions and certain immune cells from which it periodically emerges to reseed itself. This has made us rethink everything from the possibility of eradication to when to start therapy. Early attempts to flush HIV from its hiding place with chemicals called cytokines show promise but require a great deal more refinement before they lead to approaches in humans. Researchers are frantically trying to understand what it is that went right for these few patients, but they warn AIDS patients not to try this dangerous experiment on their own. This year also saw the widespread availability of new tests that determine if a person's particular strain of HIV is resistant to certain drugs.
Many new drugs are in the development pipeline.
Two highly promising types of new drugs are the fusion inhibitors, which prevent HIV from binding to target cells, and integrase inhibitors, which attack a viral enzyme crucial for HIV replication. Reports also are expected on other approaches, including various gene therapies. For the poorer nations of the world, it is generally accepted that only a relatively inexpensive and effective HIV vaccine can stop the AIDS juggernaut. Indeed, the keynote lecture at the upcoming Retrovirus conference will be a report on the state of HIV vaccines by Gary Nabel, MD, PhD, the chief of the new AIDS Vaccine Research Center at the National Institutes of Health. I say good, not excellent.