Since HIV was first identified in 1983, enormous progress has been made in understanding how the virus attacks the immune system to cause disease and in how to intervene therapeutically. NIAID-funded researchers have also made great strides in reducing mother- to-infant transmission of HIV. Twenty-seven different preventive vaccines have been evaluated, and efforts are under way to increase the number of new vaccine and microbicide candidates.
Still, research is needed to identify new strategies and tools to accelerate drug and vaccine discovery, to better understand immune reconstitution, and to determine the most promising drug candidates. Viral drug resistance remains a major obstacle to effective, long-term therapy. Finally, for HIV prevention efforts to have a global impact, effective, inexpensive, and easily administered regimens need to be developed, especially with regard to mother-infant transmission.
Epidemiologic research provides information that advances our understanding of the biology and clinical course of HIV infection. Comprehensive data and biological sample collections from individuals who are either at high risk for HIV infection or are already infected provide a complete picture of HIV infection and disease, and serve as a unique resource for investigations of immunologic, virologic, genetic, and other factors that may modulate the various stages of HIV disease.
HIV pathogenesis research increases our understanding of the biology of HIV by studying the virus' life cycle, virus-host interactions, and mechanisms of disease progression and transmission. Knowledge gained from these studies enhances the ability of researchers to create new agents and vaccines to combat HIV infection. Nonetheless, more information is needed about how the virus evades the immune system.
NIAID-sponsored therapeutics research has had a dramatic impact on the clinical management of HIV infection over the past decade. Recent studies have shown that highly active antiretroviral therapy (HAART), regimens of at least three antiretroviral drugs (i.e., reverse transcriptase inhibitors and usually at least one protease inhibitor), is capable of suppressing HIV viral load to undetectable levels in many infected individuals and partially restoring immune function. Such regimens have had a dramatic impact on HIV morbidity and mortality in this country. Nonetheless, there is an ongoing, urgent need for new therapeutic agents to control HIV replication and boost, rebuild, and/or replace immunity lost in HIV infection.
Three-dimensional image of the HIV protease enzyme critical for viral replication.
The discovery and development of a vaccine that protects against HIV infection is one of the highest priorities of the NIH AIDS research program. To accelerate identification of effective vaccine candidates, future studies will need to address the significance of latently infected cells, immune responses induced by current vaccine candidates, and the impact of HIV and HLA diversity. Because the majority of new HIV infections are occurring in the developing world, strong international collaborations will need to be formed and ethical issues addressed in order to conduct efficacy studies in developing countries.
Control of the AIDS epidemic will probably require a combination of prevention strategies, even in the presence of an efficacious vaccine. Such strategies include methods to interrupt mother-to-infant transmission of HIV; biomedical approaches, such as topical microbicides and the treatment of sexually transmitted diseases (STDs); and behavioral interventions.
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Last Updated December 19, 2011