On the 25th anniversary of the first scientific article linking a retrovirus to AIDS, Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, reflects in an essay in Nature on his experience treating and studying HIV/AIDS for the past quarter century. Outlining the peaks and valleys of the scientific communitys journey so far, Dr. Fauci writes, we must learn from our mis-steps, build on our successes in treatment and prevention, and renew our commitment to developing the truly transforming tools that will one day put this scourge behind us.
From the outset, AIDS was clearly more menacing than any other novel disease Dr. Fauci and his colleagues had previously encountered, he writes. The period when clinicians lacked the ability to diagnose and treat AIDS was the bleakest of his career. The discovery that HIV causes AIDS stimulated a burst of progress in both the clinic and the laboratory. But the 1987 debut of the first effective drug against HIV, zidovudine (AZT), generated excessive optimism, Dr. Fauci reflects, as the virus quickly and predictably developed drug resistance.
Eight years and thousands of AIDS deaths later, protease inhibitors launched a renaissance of anti-HIV drug development in 1995. Combination therapies dramatically cut the rate of AIDS deaths in the United Statesbut the developing world has continued to suffer from lack of access to effective treatments for HIV. Even more sobering, Dr. Fauci writes, Treatment alone will never end the AIDS pandemicaround three people are newly infected for every person put on therapy.
So what options remain? Dr. Fauci praises research aimed at finding a cure for HIV/AIDS and affirms that this work must continue, but he places considerable hope and energy in preventing HIV infection, most importantly through the development of a vaccine. In retrospect, he writes, the scientific community expected
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