Progress and problems in the fight against AIDS

The provision of double-nucleoside therapy against HIV/AIDS in Europe and North America is most likely responsible for the observed marked declines in AIDS-related morbidity and mortality in 1995 and 1996, while the addition of protease inhibitors resulted in further benefit in late 1996 and 1997. The number of inpatients with AIDS has decreased while the number of outpatients has increased, reflecting major improvements in the treatment of HIV infection. However, simpler treatments are needed and much remains to be learned about how to safely apply these new biomedical tools against HIV/AIDS, including the nature of therapy-related long-term complications. Furthermore, funds are still needed for ongoing research and prevention. For the average AIDS patient in developing countries, highly active antiretroviral therapy is an inaccessible dream, and merely a diversion for developing country health ministries from more pressing concerns which threatens more cost-effective programs against HIV, such as the targeted distribution of condoms or the treatment of sexually transmitted diseases which facilitate the spread of HIV. Since nothing will likely bridge this gap between poor and rich countries, only prevention and a vaccine will likely make a real difference for the poor in the battle against HIV/AIDS