Understanding of Human Immunodeficiency Virus, the virus that causes AIDS, has increased dramatically since the 1980s. When the disease first noticeably appeared in the U.S. population in 1981, the Center for Disease Control dubbed the new illness \gay-related immune deficiency."" In 1988, Cosmopolitan proclaimed on the cover, ""Women, you do not need to worry'You can't get AIDS.""
Today, researchers in laboratories and clinics across the globe are developing new treatments and building on their already extensive understanding of the virus.
""There is more knowledge about HIV than any other virus,"" said Miroslav Malkovsky, a UW-Madison professor of Medical Microbiology and Immunology. ""We know the shape [of the virus], the genes, how it replicates. There are literally tons and tons of information,"" Malkovsky said.
Learning about HIV has come at a price.
Two billion dollars have been spent on AIDS research to try to understand how the disease progresses, according to Malkovsky.
That research has led to innovative drug therapies, such as protease and nucleoside reverse transcriptase inhibitors. The inhibitors can drop the amount of HIV in the body to undetectable levels. In the mid-1990s, those drugs, given as a combination or ""drug cocktail,"" gave HIV-infected individuals healthier and longer lives.
""[These] treatments, in the short term, have really made a difference,"" said Dr. James Sosman, the medical director of the Midwest Training and AIDS Education Center.
""Six years ago when the AIDS cocktail [emerged as a new treatment], we didn't know if we would get one year or six months of benefit [from the drugs]. Now we know there clearly are benefits,"" Sosman said.
In 2000, almost 40,000 more people were living with AIDS than two years before. And the number of deaths in the United States from AIDS-related illnesses dropped under 17,000'a number that had not been seen since the mid-1980s, according to the CDC.
But there remains cause for concern.
""If you take 100 people, 10 or 11 years later 50 percent would be classified as having developed AIDS,"" Malkovsky said.
""People can develop AIDS as soon as a half of a year [after infection]. A small percentage, 2 to 4 percent of infected individuals, have not developed AIDS 20 years later,"" Malkovsky said.
Because the drug therapies are not fully effective, researchers are still searching for better ways to prevent AIDS. Scientists are investigating whether vaccines could be a useful option. According to Malkovsky, many different kinds of vaccines are currently being tested on human volunteers in the United States.
The new research on vaccines is exciting and interesting, said Sosman, but not reaching its intended goals.
""Unfortunately there have not been any clinical rewards for that [research]. We've learned a lot about [the branch of science that studies the immune system], but it hasn't led to the development of a vaccine.""
Another cause for concern was recently presented at the American Society of Microbiology. A study showed that about half of HIV patients carry a strain of the virus that is resistant to at least one drug. And among newly infected patients, 20 percent carry a strain that is resistant to at least one drug. The study has increased fear that the drugs may lose their potency in the future.
Furthermore, the side effects of these powerful drugs can be difficult to live with.
One of the more recently discovered side effects is lipodystrophy, a condition that leads to high fat levels in the blood and can cause bloating of the stomach, chest, arms, face and legs.
""It is a fat redistribution. Fat 'grows' in some places and deposits in others. In some people, it can be disfiguring,"" Sosman said.
Another side effect can be peripheral neuropathy. Neuropathy can cause degeneration of the nerves in the hands and feet and it can also cause problems with vision.
Even with all the current knowledge of AIDS, researchers still do not understand what causes the disease to progress from the initial HIV infection, which can be symptomless, to full-blown AIDS, which is when a patient is susceptible to infections because of the damage HIV does to the immune system.
""Some people progress, some don't. We do not really know what makes this difference. What change in the body causes the immune system to give up?"" Malkovsky said. ""The immune system can contain the virus over a period of many years. Somehow the situation leads to degeneration of the immune system. [If we understand] how that happens then it is a very short step to effective treatment of AIDS, "" Malkovsky said.
But an effective AIDS treatment will only be discovered if there is another breakthrough in HIV research'a breakthrough that could take months or years.
""I believe it will happen eventually, [but] it can happen tomorrow or never in our lifetime,"" said Malkovsky.
