CHANGING THE NATURAL-HISTORY OF HIV DISEASE

Our understanding of the pathogenesis of AIDS has advanced considerabl y since the disease was first reported 15 years ago. We now know that the primary damage inflicted by HIV-1 is mainly brought about by activ e virus replication. With the advent of sensitive tools for monitoring HIV replication in vivo, an individual's risk of disease progression can be assessed early in the course of the infection and the efficacy of antiviral therapies can now be determined accurately and expeditiou sly. When used appropriately, potent combinations of antiviral drugs s eem to be able to circumvent the inherent tendency of HIV-1 to generat e drug-resistant viruses, the main reason for failure of all antiviral therapies, and are significantly more effective than earlier approach es. For the first time, rational approaches to contain and perhaps eli minate HIV-1 infection can be pursued.