Roger J Pomerantz; David L Horn


Nat Med. 2003;9(7) 

In This Article


The first 20-year leg of the journey toward discovery of effective antiretroviral therapy since the isolation of HIV-1 has been marked with exuberant optimism and tempered by factors mitigating totally successful therapy. AIDS started as a highly fatal infection but has become a treatable, chronic infectious disease in the developed world as a result of the development of antiretroviral therapy. Despite all of the setbacks and obstacles, which include HIV-1 resistance to current therapy, metabolic complications, adverse events and adherence difficulties, the overall improvement in therapy markedly increases every few years with the prolongation of survival in HIV-1-infected patients. New agents such as fusion, entry and integrase inhibitors, improved drug discovery processes and better understanding of both HIV-1 virology and general immunology are likely to accelerate the pace of development of more potent therapeutic regimens and, eventually, of a prophylactic vaccine. The great requirement of affordable agents and appropriate approaches for the developing world needs to be addressed, as this is where most of the epidemic has occurred and will be sustained. As we look forward, the ultimate goals of eradi-cation of HIV-1 from infected individuals and protection from infection through vaccination will remain challenging to achieve. Nevertheless, the potential to completely control or suppress the virus in infected individuals is likely to become achievable in the near future.

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