Current and future HIV/AIDS clinical research. HIV-related therapy improving--slowly

More than 300,000 cases of AIDS have been reported in the United States since 1981. Despite major scientific advances and much effort, the benefits of treatment have been modest. The variable nature of the human immunodeficiency virus (HIV) and the complexity of the immune system are the major obstacles to advances in treatment. This article summarizes the current state of clinical research in pursuit of improved HIV therapy and takes a look into the future of anti-HIV therapeutics. It also provides an overview of HIV clinical research underway in Minnesota. Research efforts to improve therapy of HIV-induced immune deficiency will involve three strategies: better anti-HIV drugs and combinations of drugs aimed at slowing the replication of HIV, immune-based therapies intended to stimulate the immune system, and multiple opportunistic pathogen prophylaxis strategies to prevent HIV-related opportunistic infections. This approach will involve considerable cost and polypharmacy. Improvements in HIV/AIDS therapy are likely to occur incrementally, but the endeavor needs widespread support from patients, physicians, and the public. For now, the best strategy is prevention, which is where physicians can have the greatest impact on the epidemic.