A perspective on HIV/AIDS: What could the future hold?

Abstract

First detected a quarter century ago, the Human Immunodeficiency Virus (HIV) has rapidly become the major public health communicable diseases problem globally, with southern Africa responsible for approximately two-thirds of all deaths. The virus, HIV-1, arose from chimpanzees in Africa probably in the early 1930's. Having crossed the species barrier the virus adapted to human-to-human transmission and its subsequent spread was facilitated by the sexual and drug abuse habits of modern society. Important breakthroughs in the control of HIV/AIDS (Acquired Immunodeficiency Syndrome) have been the development of very high performance diagnostic tests resulting in the virtual elimination of blood transfusion as a route of transmission and, secondly, the advent of some two dozen antiretroviral drugs. Cocktail combinations of these drugs, referred to as HAART (highly active antiretroviral therapy), have been successful in halting the progress of the disease in patients for many years. They have also been most successful in preventing mother-to-child transmission of the virus. However, the development of a preventive vaccine, probably the only totally effective option to control the pandemic, has not yet been successful. This has primarily been due to the nature of the virus itself—it is the most highly mutable virus known and consequently its changes in antigenicity have greatly complicated the design of a vaccine. It is likely that a successful vaccine is still at least a decade or two away and other modes of prevention will need to be depended on such as safe sex practises, male circumcision and perhaps, in the near future, effective microbicides.