By Sean Henahan, Access Excellence

VANCOUVER (7/8/96)- While recent clinical trials give some reason for optimism, AIDS researchers, whether working in the lab or in the field in the developing world, face considerable obstacles, said Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, speaking at the XIth International Conference on AIDS.

"The field of HIV therapeutics was given a double boost of optimism over the past year. First, combinations of nucleoside analogs compared to zidovudine (AZT) alone were shown to have a clinical benefit (prolonged survival and fewer AIDS-defining events) when given to asymptomatic individuals with relatively early-stage disease. This was the first demonstration that an intervention regimen used in early-stage patients could actually be clinically beneficial in HIV disease.

"Next came the demonstration of the extraordinary capability of protease inhibitors to block virus replication. The use of this new class of drugs in combination with the first generation nucleoside and non-nucleoside reverse transcriptase inhibitors holds great promise for a level of control of established HIV disease that has so far eluded patients and physicians. Furthermore, the use of these regimens in primary HIV infection holds promise for interfering with the establishment of chronic persistent infection and dramatically altering the subsequent course of HIV disease."

However, now is no time for complacency, he emphasized. The AIDS epidemic is still 'out of control' in the developing world. Furthermore, major gaps in the scientific understanding of AIDS still exist. For example, the precise mechanisms of CD4+ T-cell destruction in vivo remain unclear. Also, the identity of the correlates, if any, of protective immunity against HIV, critical to the efforts at vaccine development, are not known.

"Despite the dramatic advances in therapeutics, important questions remain regarding the optimal use of combinations of antiretrovirals, including the protease inhibitors. We do not know whether early intervention in asymptomatic, infected individuals will result in a long-term clinical benefit, or whether the cumulative toxicity over years of drug administration and the potential for the development of drug resistance will outweigh the potential benefits of these drug regimens," he commented.

Related information on the Internet

XIth International AIDS Conference

JAMA HIV Info.

HIV Replication Primer

HIV Pathogenesis

YAHOO AIDS DIRECTORY