American Foundation for AIDS Research, May 2001
David Gilden

What have we learned?

Twentieth anniversaries usually are cause for celebration, but this one obviously is not: On June 5, 1981, the CDC's Morbidity and Mortality Weekly Report carried a curious but otherwise unremarkable account from Los Angeles that in the past eight months, "5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia." In July and August, the MMWR carried a descriptions of 26 cases of Kaposi's sarcoma along with 15 more cases of PCP in New York and California. It turned out that these gay men had lots of other symptoms related to immune deficiency, and the AIDS epidemic was on.

It is frequently forgotten that the first known cases of AIDS took place in babies whose mothers were New York City drug addicts and/or "sexually promiscuous." These cases did not receive public recognition until 1983. Women, who have formed a minority of persons with AIDS in the United States, were slighted by scientific research ever since. This has been true despite clear differences in opportunistic conditions and even in the way they react to HIV infection.

Now, women are making up a growing proportion of people with AIDS. Improvements in treatment have disproportionately slowed the epidemic's progression in men, as have AIDS prevention efforts. Behind the increasing percentage of women is a murky mix of social and biologic factors that are finally becoming the subject of research.

A renewed emphasis on women's research is the subject of the first article in this Treatment Insider. The second major article concerns another old question. HIV pioneer Jay Levy of the University of California noticed in 1986 that certain immune cells were able to very effectively suppress HIV in the body. They used some sort of soluble chemical signal that affected only the HIV-infected cells. This highly intriguing observation could potentially yield very effective, safe treatments for HIV infection, but to this day no one has isolated these cells or the substance they produce. The big research dollars have instead gone to discovering the chemical anti-HIV agents that make up combination therapy.

Poor women and natural molecules: unsolved questions lacking powerful constituencies have gone by the board. What have 20 years brought us? Declining death rates and more long-term management of HIV, to be sure. But at the end of these two decades, HIV is still here and many of its basic mysteries remain. And the hope of eradicating the virus hangs in the balance.

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Copyright © 2001 by the American Foundation for AIDS Research (amfAR) and first displayed on amfAR's Treatment Directory web site (http://www.amfar.org/gl). They appear on AEGIS with amfAR's permission. Organizations wishing to reprint or redistribute these materials should request authorization from amfAR's Department of Treatment Information Services (212/806-1600).

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