Research updates
HIV - a global challenge   page 7
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6. Future prospects Link to the Medical Research Council web site
Heralded by Science journal as ‘1996 breakthrough of the year’ was the discovery of membrane-bound co-receptor molecules, which are essential for the entry of HIV into macrophages and T-cells.
Interactive diagram of CCR5 receptor
Figure 8. Open sesame: HIV uses chemokine receptors like CCR5 to enter CD4 T–cells.
How HIV enters a CD4 T–cell
It had been known for some 10 years that the binding of HIV to the CD4 receptor alone was not enough. To date, two co-receptors have been identified. One of them, CCR5, seems to be used during the early stages of HIV infection. The normal role of the CCR5 molecules is as receptors for proteins - chemokines - involved in the immune system’s inflammatory responses.

Interestingly, research revealed that particular chemokines are also suppressors of HIV infection, as they block the CCR5 co-receptor molecules.

At the same time scientists found that, despite exposure to HIV, some individuals with a genetic defect in their CCR5 receptor are highly resistant to HIV infection. Both findings offer new insights into the life cycle of HIV and may lead to new treatments or vaccines.

Treating HIV in the future

The view has been expressed that with powerful combination drug therapy it may be possible to eradicate HIV in a patient within several years. However, many researchers and clinicians feel this view is rather optimistic. Although undetectable in the blood, HIV may well be lurking in ‘sanctuary sites’, tucked away in various cells of the body.

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What about prevention?

The prospects for an effective vaccine remain uncertain, but there is no doubt that the antiretroviral drugs currently available are both prolonging survival and allowing a better quality of life for HIV-infected individuals. A sobering statistic, however, is that more than 90% of all HIV-infected people live in developing countries with poor resources. Most of them lack access even to AZT, let alone expensive combination drug therapy. Clearly, prevention of HIV transmission remains crucial, and political will must underpin scientific developments in the worldwide battle against HIV and AIDS.

As we now know that there is not going to be one single answer to the problem of AIDS, future scientific developments are most likely to come from a multidisciplinary approach.