In This Article

Abstract and Introduction

Although the future of HIV science is uncertain, we need to reappraise HIV diversity, pathogenesis and immunity. The AIDS pandemic threatens the success of existing vaccine programs and may accelerate the emergence of new infectious diseases.

Apollo conferred on Cassandra the gift of clairvoyance but later added the caveat that no-one would listen to her prophesy; thus, her warnings of the fall of Troy and the House of Agamemnon went unheeded. Doctors and scientists are less farsighted, and making predictions exposes us to ridicule in hindsight. Not long after the US Surgeon General declared that it was "time to close the book on infectious diseases", HIV began to 'cruise' the San Francisco bath houses while severe acute respiratory syndrome (SARS) lay further in the future. In 1984 Margaret Heckler, then US Secretary for Health and Human Services, declared on behalf of the National Institutes of Health that "we hope to have a [AIDS] vaccine ready for testing in about 2 years."

How foolhardy it was to accept an invitation from Nature Medicine to comment on the next 20 years of HIV science! If we could foresee the future of research, then we would surely be doing it now. The other contributors to this issue have made the sensible prognostications, whereas anything I put forward here must be regarded as unsure prediction, idle speculation or even wild conjecture.[1]

The pace of HIV science, like all science, is driven by technology with unexpected breakthroughs. Without PCR, we would not have accurate measurements of HIV viral load and turnover; without rapid DNA sequencing and bioinformatics, we would not have such an exquisite database on HIV genetic variation; and if plant virologists had not been curious to investigate gene silencing, we would not have RNA-mediated interference (RNAi) as a medical research tool. Thus, my message for future progress on HIV is that we ignore non-HIV research at our peril. No doubt this prophesy will fall on deaf ears at the funding agencies, especially those in the charitable sector: the late Bernie Fields' exhortation[2] to "get back to basics" in HIV science is not part of their mission.

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