Prospects for the future

The worldwide impact of the AIDS epidemic will be considerable as millions of deaths occur. We can assume that for the next 5 years there will be no cure to treat infections and no vaccine to prevent them. There will be, however, palliative treatments that will prolong life to some extent. These, however, most likely will be quite expensive and carry considerable side effects. As for vaccines, there most likely will be prototypes under study, but no generally available product. In the United States and western Europe, most of the cases will continue to occur in the "first wave" groups, but over decades increased blurring of epidemiologic boundaries will occur as sexual partners of infected people develop the disease. Ultimately, if nothing is done to stop transmission, the epidemiology in these areas will parallel that of hepatitis B virus. But something will be done. Programs will be designed and carried out to care for patients and prevent further transmission. In the United States, the National Academy of Sciences (1) and the surgeon general (2) have outlined approaches to take. In places where well-planned programs have been implemented, improved health care and decreased transmission of the virus have resulted. Areas of the world and individuals in those areas which put forth effective treatment and prevention programs will no doubt fare better than those that do not.