Question:

Doc, can you tell me with all of todays current technology, will we have an AIDS/HIV cure by 2007?

Also, is it possible to have a child from an HIV- mother and a HIV+ father and the child be HIV- at birth ??

Answer provided by:

Rodger MacArthur, M.D.
Wayne State University
Division of Infectious Diseases

HIV has been present in humans for at least 65-70 years. Researchers in the United States and France first identified HIV as the cause of AIDS in 1983-4, about 3 years after the medical profession became aware of the syndrome of AIDS. At the time of the first reported cases of gay men with either Pneumocystis carinii pneumonia or Kaposi's sarcoma (1981), there were no antiretroviral agents available to inhibit the replication of HIV. The first antiretroviral agent, AZT, was approved for use in HIV infected persons in 1987; since then, an additional 20 antiretroviral agents have been approved for use in HIV infected persons in the United States by the Food and Drug Administration (FDA).

Still, there is not a "cure" for HIV. Or, more specifically, physicians and scientists have not been able to find a way to eradicate HIV from the body. On the other hand, there have been many "immunologic cures". That is, as a result of combination antiretroviral therapy, HIV-infected persons with moderately-to-severely weakened immune systems now are immunologically "normal": they are no longer at any risk of HIV-associated infections. Many persons with HIV infection have lived at least 20 years since being infected. There is every reason to believe that someone who becomes infected with HIV today can live 30-40 years or more, albeit with considerable time spent taking antiretroviral therapy. HIV, in the United States, Canada, Australia, and Western Europe, has become a chronic condition which can be controlled, but not eradicated, with currently available therapy. As such, HIV is similar to infection with herpes simplex virus or other viruses that are not eradicated, but successfully treated or suppressed with antivirals and/or the body's own immune defenses. HIV infection is no longer a "death sentence", although it remains a condition better prevented than treated, given the issues of tolerability, toxicity, resistance, and adherence associated with chronic antiretroviral therapy. HIV infected persons in the United States and the other countries mentioned above are as likely to die with HIV as they are to die because of it.

There are many reasons why HIV is difficult to eradicate. The virus circulates in a number of sufficiently different variants that vaccine development has been difficult. Furthermore, HIV infects the very cell (CD4+ lymphocyte, or "helper T-cell") that many vaccines try to stimulate to fight other infections. And, significantly, HIV incorporates itself into the host genetic material, where it can remain dormant for decades (within latent, or "resting" lymphocytes). Currently, HIV can be killed only when it is active (replicating). Unfortunately, the prospects of a developing a vaccine to prevent infection or to help boost the immune system (with or without eradicating HIV) are not much better today than they were 10 years ago. Control of the virus with antiretroviral therapy, and prevention of new infections, remain the best hopes for stopping the HIV epidemic in the foreseeable future.

A baby born to an HIV-negative woman, who conceived the child from an HIV-positive man, will be HIV-negative. The HIV-negative woman, in her attempts to conceive the child, puts herself at risk of acquiring HIV from her HIV-positive partner. As long as she remains HIV-negative, any baby born to her also will be HIV-negative. There are techniques available to reduce the HIV infection risk to the woman, such as "sperm washing" which involves separating the HIV-infected semen from the sperm, but no technique reduces the risk to zero. In addition, HIV-infected persons with undetectable amounts of virus in the blood are at lower (but not zero) risk of infecting a partner.

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