In This Article

Abstract and Introduction

From the identification of HIV as the agent that causes AIDS, to the development of effective antiretroviral drugs, the scientific achievements in HIV research in the past 20 years have been formidable. Some of the other important areas of accomplishment include the development of blood tests for HIV and increased knowledge of the molecular virology, epidemiology and pathogenesis of this virus.

The pandemic of HIV infection, the cause of AIDS, is clearly the defining medical and public health issue of our generation and ranks among the greatest infectious disease scourges in history.[1] Since the world first became aware of AIDS in the summer of 1981 (refs. 2,3), the disease has spread in successive waves in various regions around the globe. By 2003, HIV had infected a cumulative total of more than 60 million people, over a third of whom subsequently died.[4] Unfortunately, the catastrophic potential of the AIDS pandemic has not yet been fully realized. HIV and AIDS continue to exact an enormous toll throughout the world, notably in sub-Saharan Africa, and their incidence is accelerating in some countries and regions, including China, India and parts of eastern Europe and central Asia.[4]

Commensurate with the magnitude of the HIV and AIDS problem has been the extraordinary scientific effort to delineate the etiology, molecular virology, natural history, epidemiology and pathogenesis of disease caused by HIV (reviewed in refs. 5-8). These areas have paved the way for the development of effective therapies and tools of prevention that have provided enormous benefits to individuals and communities in resource-rich countries and increasingly also in resource-poor countries.

As we look back on the 20 years since the identification in 1983 of HIV as the etiological agent of AIDS,[9,10] it is appropriate to reflect on some of the many accomplishments in AIDS science, as well as the numerous challenges that remain. Thousands of investigators in diverse disciplines have contributed to an effort that has resulted in an extraordinary, but still incomplete, mosaic of understanding with regard to HIV and AIDS. The collective output of the HIV and AIDS research community has been prodigious: more than 125,000 papers related to HIV and AIDS are catalogued in the PubMed database of the National Library of Medicine.

Although it would be impossible to describe all of the important scientific contributions in HIV and AIDS research within the context of a brief commentary, I have attempted to highlight in broad strokes some of the main areas of accomplishment in the fight against HIV and AIDS without attempting to be all-inclusive. Other authors in this focus will discuss these and additional topics in greater detail.