The progression of HIV disease in the setting of vigorous anti-HIV responses remains a central paradox in the pathogenesis of HIV infection.[6,8] Elements of both the humoral and cell-mediated immune responses against HIV have been implicated in the partial control of viral replication. Even after 20 years of HIV and AIDS science, however, our lack of understanding of the correlates of protective immunity in HIV infection continues to hamper the rational development of HIV vaccines. With 14,000 individuals worldwide becoming infected with HIV every day, a vaccine that prevents HIV infection or at least slows the progression of disease in individuals who become infected is badly needed.
Despite the lack of a clear understanding of the correlates of protective immunity in HIV infection and other formidable obstacles, significant progress toward an HIV vaccine has been made. At the time of writing, numerous promising HIV vaccine candidates are in various stages of preclinical and clinical development. But it is still not clear at this point how successful, if at all, we will be in the development of a vaccine that truly protects against HIV infection. Candidate vaccines in nonhuman primate models generally have not been able to protect against infection, but they have shown protection (at least for a time) against disease progression in primates that become infected despite having been vaccinated. The superinfection of already-infected individuals whose current virus had been under excellent immunological control is a troubling observation. Clearly, the development of a safe and effective vaccine for HIV is one of the most formidable challenges for research in infectious diseases.
The scientific accomplishments in the field of HIV research over the past 20 years reflect an extraordinary odyssey of discovery. Indeed, these accomplishments represent a model of what can be accomplished when the world's scientific community is galvanized in a common goal of pitting its best minds and substantial resources against a historic public health challenge. This Nature Medicine special issue will take up in detail these and other crucial accomplishments in the scientific response to HIV and AIDS.
Unfortunately, the HIV pandemic still rages throughout the world, particularly in resource-poor countries such as those in sub-Saharan Africa, the Caribbean and parts of Asia. This fact should energize the scientific and public health communities to continue the quest for scientific discovery and, simultaneously, to ensure that the fruits of scientific discovery are adequately applied to those most in need.
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I thank G. Folkers for help with preparing the manuscript and H.C. Lane for critically reading the manuscript.
Nat Med. 2003;9(7) © 2003 Nature Publishing Group
Cite this: HIV and AIDS: 20 years of science - Medscape - Jun 01, 2003.