Actively immunizing patients with HIV-1: Progress on the development of a therapeutic vaccine

Extract: Despite more than twenty years of research relating to HIV-1, human immunodeficiency virus type-1, HIV-1 infection remains a public health threat of extraordinary proportions. The World Health Organization estimates that in the year 2003 alone, 4.8 million people were newly infected with HIV-1, approximately 38 million people were living with HIV-1 or suffering from acquired immunodeficiency syndrome (AIDS), and 2.9 million individuals died as a result of AIDS-related diseases. Since the first cases of AIDS were identified in 1981, 20 million people have died as a result of HIV-1 infection. With the advent of highly active antiretroviral therapy (HAART), the morbidity and mortality associated with HIV-1 infection have been dramatically reduced. However, additional studies have shown that long term HAART by itself is unlikely to be a cure for HIV infection and that cessation of HAART is inexorably followed by a rebound in HIV replication. Furthermore, the cost of lifelong HAART, the complex dosing regimens required, the toxic side effects of the medications and the limited availability of these drugs in developing countries, all suggest that HAART itself may be ill-suited to constrain the HIV pandemic. These issues indicate that alternative treatment strategies capable of effecting durable and sustained viral suppression are urgently needed.