AIDS: clinical and scientific issues past, present and future

The time from the recognition that AIDS was an infectious disease, to the discovery of HIV as the causative agent and the identification of the first specific antiviral agent that showed some clinical benefit, was impressively short. Over the last few years it would appear that progress against AIDS has slowed down considerably. Neither new treatments nor vaccines have given much grounds for optimism and back to basics has been the main battle cry. However it is easy to overlook the tremendous improvements that have taken place in the management of HIV disease in the absence of a curative treatment. Many of the opportunistic infections that used to kill patients are not only treatable but are able to be treated prophylactically. This has altered the clinical spectrum of disease with many patients surviving several years with virtually no CD4 lymphocytes only to succumb to other HIV related disease such as non Hodgkins lymphoma. This review identifies the major advances that have occurred in our understanding of AIDS and identifies the major problems to be overcome in the next few years at both the clinical and basic levels.