AIDS Therapy in the New Millennium
Recovery of immune function is the key to the future of AIDS therapy. Most patients who receive anti-HIV drugs regain strong immune responses -- but for reasons that remain unknown, these immune responses do not work against HIV itself.
"What you have to do is boost the immune system -- that is really the secret to controlling this virus," Levy says. "You might do it by immunization, but we don't have a good vaccine. Or the more recent emphasis is going to be on structured treatment interruptions, where you stop the drugs for a while, let the virus come back up so the immune system can get a look at it, and then restart the drugs again. And [the immune-boosting substance known as] IL-2 has regained popularity." He explains that IL-2, when given with HAART, increases infection fighting cells, but unfortunately, they don't target the HIV. "Now the question is how to program those returning cells to fight HIV," he says
These medical questions are not the only clouds looming on the HIV horizon. Atlanta's Johnson says that for the first time in a long time, she is seeing a steady increase in people newly infected with the AIDS virus.
"It is alarming that we are seeing a resurgence of new HIV diagnoses," Johnson says.
Mellors predicts that he will see the same thing. "We are seeing a resurgence of HIV risk behaviors so it is only a matter of time," he says. "I don't want to sound pessimistic, but it is almost predictable that we have great resources and motivation as human beings for only a short period of time. It's our attention span. This is the same thing that occurred with tuberculosis -- absolutely the same thing. It will be two steps forward and one step back -- that is the story in most infectious diseases. For global control of AIDS, we are really talking about the need for an effective vaccine. This is not to say that for individuals the drugs can't have great benefit -- but for the disease as a whole, it will be to and fro for a long time to come."