Commentary in 2003

Scaling up access to antiretroviral drugs (ARVs) for HIV-infected adults and children in developing countries can no longer be refused for medical or economic reasons, or on the grounds of inequality, lack of infrastructure, risk of viral resistance or alternative priorities. Access to ARVs is an appropriate, rational and cost-effective investment choice in developing countries.

Between the first analysis of patient samples in early 1983 and the determination of the sequence of HIV-1 in 1985, a vast amount of data was accumulated on HIV through the integrated efforts of clinicians, virologists, immunologists, molecular biologists and epidemiologists. These early years of HIV research quickly led to strategies for the diagnosis, monitoring and treatment of HIV/AIDs

Although the future of HIV science is uncertain, we need to reappraise HIV diversity, pathogenesis and immunity. The AIDS pandemic threatens the success of existing vaccine programs and may accelerate the emergence of new infectious diseases.

From the identification of HIV as the agent that causes AIDS, to the development of effective antiretroviral drugs, the scientific achievements in HIV research in the past 20 years have been formidable. Some of the other important areas of accomplishment include the development of blood tests for HIV and increased knowledge of the molecular virology, epidemiology and pathogenesis of this virus.

S-nitroso-hemoglobin (SNOHb) has been proposed to regulate blood flow and tissue oxygenation through allosterically controlled binding and delivery of nitric oxide (NO) and oxygen in the vasculature. This precept and the experiments that test it have provoked both ardent support and expanding dissent. An alternative view suggests that a physiologically tightly regulated balance of NO scavenging by hemoglobin and NO production by endothelial cells determines NO bioavailability.

At the crossroads of academia and industry, translational research provides the vehicle for the application of medical discoveries and developments. A productive and expanded relationship between these two sectors is essential for the continued success in translating basic research findings to the clinic.

Chromosomal translocations occur in leukemias, lymphomas, sarcomas and some epithelial tumors and some generate unique fusion proteins. These translocation products may provide tumor-specific targets for the development of new therapeutic strategies tailored to a malignant cell.

In cell encapsulation, transplanted cells are protected from immune rejection by an artificial, semipermeable membrane, potentially allowing transplantation (allo- or xenotransplantation) without the need for immunosuppression. Yet, despite some promising results in animal studies, the field has not lived up to expectations, and clinical products based on encapsulated cell technology continue to elude the scientific community. This commentary discusses the reasons for this, summarizes recent progress in the field and outlines what is needed to bring this technology closer to clinical application.

If vaccines could be administered without needles and syringes ('sharps'), immunization practice would become safer, more accepted and more suitable for mass use. The author explores the status of technologies that could achieve this aim and the barriers that must be overcome for their implementation.