HIV Treatment Proceeds as Prevention Research Confounds

Editorial W orld AIDS Day, the annual December 1 commemoration, first took place in 1988 under the auspices of the Joint United Nations Programme on HIV/AIDS [1]. At that time few had recognized the epidemic's impending global scope or envisaged how to provide AIDS treatment in developing countries. During the previous year, the United States Food and Drug Administration (FDA) had licensed zidovudine (AZT), the first drug shown to be effective for treating HIV. AZT, which quickly became available in North America and Europe, provided modest hope for the first time since the initial reports of AIDS in 1981. Taken as a single drug every four hours round the clock, it could prolong life by half a year or more [2]. Twenty years later, HIV treatment has the potential to become one of medicine's success stories. Combination anti-HIV therapies, referred to generically as highly active antiretroviral therapy (HAART), began to appear around 1996. Although costly and not without adverse effects, these " cocktails " have proved so effective that many who narrowly escaped death from AIDS in the mid-1990s are now facing the usual health concerns of advancing age. Although emergence of drug-resistant virus creates ongoing challenges, HIV treatment has continued to advance, as evidenced by the development of more convenient treatment regimens, and by FDA approval in 2007 of drugs from two new mechanistic classes: the first integrase inhibitor and the first chemokine receptor blocker. On the global scale, 2007 has seen further progress in the impressive effort to address financial and logistical barriers to providing HIV treatment in low-resource settings. Although some 5 million people remain in need of HAART, and a recent systematic review found that many who begin HAART in developing countries do not continue treatment [3], the fact that more than 2 million people in low-and middle-income countries are now receiving HAART marks significant progress. In this context of global progress toward HIV treatment, the official theme of World AIDS Day 2007 appropriately calls on " Leadership " to " Keep the Promise " of universal access to HIV care and services. Pounds of much-needed treatment, however, should not obscure the fact that precious ounces of prevention remain elusive: interrupting HIV transmission remains one of the world's greatest scientific challenges. Indeed, in contrast to the progress made in treatment, World AIDS Day 2007 marks the end of a particularly sobering year in HIV prevention science, …