Reports published in the May issue of the journal Nature Medicine reaffirm the view that vaccination is the only realistic strategy against human immunodeficiency virus, HIV-1, which causes AIDS. Because HIV-1 is a disease of the immune system designed to combat diseases, strategies to fight the virus are full of paradoxes. One is the growing realization that vaccination - in other words, further challenging the immune system of a patient whose immune system is already under attack - could give it extra impetus to combat the infection.
Although the cocktail of anti-viral drugs currently offered to patients is very effective in the short term, Janet D. Siciliano of Johns Hopkins University School of Medicine, Baltimore, Maryland and colleagues show that combination therapy will never get rid of the virus completely. Instead, the virus lies low inside a small but persistent reservoir of immune-system cells. Eradicating this reservoir in any particular patient might take an average of 60 years of uninterrupted antiviral therapy, the researchers say. This is bad news, in view of the fact that the long-term use of combination antiviral therapy has unpleasant side-effects. Clearly, something else is required to eradicate the virus.
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