AIDS: The Final Chapter?

When the first report of what came to be known as “AIDS” was published in the Morbidity and Mortality Weekly Report of June 1981, few could have predicted the devastation the disease would wreak. What became clear in the ensuing months, however, was the urgent need for a venue for publishing research findings that would help scientists grapple with the mysterious new killer.

In 1983 we saw the founding of the AIDS Medical Foundation (which later became amfAR) and that of AIDS Research and Human Retroviruses, the first journal dedicated solely to AIDS research. Together, they began to fill the gaping holes in our knowledge of a disease in which many researchers and even some physicians refused to be involved.

The need, however, was great. By the end of 1983, 4,661 AIDS cases had been reported in the United States alone. By 1993, that number had risen to 414,792, and to 908,765 by 2003. The latest data from the Centers for Disease Control (CDC) indicate that almost 1.2 million AIDS cases have been reported in the United States. By the year 2000, more Americans had died of AIDS-related causes than had died in combat during the entire twentieth century.

Now, 30 years after the launching of AIDS Research and Human Retroviruses, it is awe-inspiring to consider how much has been learned. Today, a person diagnosed and treated in their 20s may reasonably expect a lifespan that rivals that of his or her uninfected counterparts. Such an outcome was unimaginable in the early days of this journal, and is due largely to the advent of highly active antiretroviral therapy.

The current state of knowledge on the first class of HIV drugs, the reverse transcriptase inhibitors, was reviewed by Eric de Clercq in 1992, ¹ the same year Christine Debouck ² described the potential of protease inhibitors as another means of treating HIV infection. Just a year later, with funding from amfAR, Carl Wild et al. described for the first time the peptide that would later become Fuzeon. ³ Since those early days, HIV treatment has become more complex and nuanced. The journal continues to serve the AIDS research community by publishing articles describing those challenges—such as toxicities, comorbidities, and resistance mutations. ^{4 –8}

Today, we find ourselves at a critical juncture. Before us stands the opportunity to end an epidemic that has taken the lives of 36 million people around the world, and continues to affect the lives of tens of millions more. To bring an end to AIDS, we need effective means to prevent HIV transmission and a cure for those who are already infected.

Although the first reported cure of HIV ⁹ —only 4 years ago—served as the first impetus for many researchers and funders, amfAR has funded cure research for more than 10 years and has supported some of the most important such work to date, including the characterization of the Berlin patient, ¹⁰ the Mississippi child, ¹¹ and the Boston patients, ¹² as well as basic research findings describing the lack of viral evolution in reservoirs, ¹³ a comparison of assays to measure the size of the viral reservoir, ¹⁴ the lack of killing after viral reactivation, ¹⁵ and the characterization of noninduced proviruses. ¹⁶ There has been growing optimism within the scientific community that with the necessary resources, a cure—long thought impossible—might be achievable within our lifetime. Unfortunately, U.S. budget sequestration and a steady decline in the purchasing power of the National Institutes of Health over the past decade have had adverse effects on the number and the budgets of the grants funded.

AIDS Research and Human Retroviruses continues to track progress being made in the search for an AIDS vaccine. ^{17 –19} Yet there are other means of decreasing HIV transmission. ²⁰ Condoms, when used consistently and correctly, decrease the likelihood of transmission by 85% or more. ²¹ Syringe exchange programs reduce the sharing of needles and have brought HIV transmission among injection drug users almost to zero in New York City. ²² Even antiretroviral therapy, used either as preexposure prophylaxis, ²³ as a topical application, ²⁴ or for the early treatment of the infected partner in serodiscordant couples, ²⁵ drastically reduces the spread of the virus. However, ideological squeamishness (in the case of condoms and syringe exchange) and lack of political will threaten our ability to put those hard-won scientific insights to work.

Improving public health through science requires three basic elements: the generation of new scientific knowledge, the sharing of that knowledge with peers, and the implementation of those interventions that have been proven effective. amfAR and AIDS Research and Human Retroviruses continue to play vital roles in the first two. We hope that we can depend on our lawmakers, and on other governments and funders, to deliver on the third.

We look forward to the day when AIDS Research and Human Retroviruses will be able to publish the best kind of AIDS story—the one that describes how the efforts of thousands of researchers working around the world have brought us a world free of AIDS.