Any condition that exacerbates this situation, such as an opportunistic infection, further promotes disease progression. Opportunistic infections, we continue to learn, play an intimate role in the pathogenesis and natural history of HIV infection, from the molecular to the clinical level. But Not Yet Gone Currently, the major focus of HIV infection remains viral pathogenesis and antiretroviral therapy. Insights into these areas in the coming years should yield both better and more durable therapies and, one sincerely hopes, a viable vaccine. In spite of this, we should not turn our backs on opportunistic infections, and it would be shortsighted to think that future Retrovirus Conferences need not include this category.
Opportunistic infections are in decline, to the joy and excitement of the entire community.
They are not, however, yet gone. Patients continue to suffer from and die of opportunistic infections, not only in the developing world, where antiretroviral therapy remains a mirage, but also in places where HIV therapy is most advanced. The durability of the current honeymoon effected by the protease inhibitors is unknown and not assured. In addition, as immune reconstitution becomes the norm in patients with advanced HIV disease, new and unusual expressions of opportunistic infections and the host response to them will occur. Finally, the careful study of the interaction of HIV, opportunistic pathogens and their human hosts will continue to yield important insights into the natural history of AIDS and the fundamentals of immunology.