Clinical Research in the Acquired Immunodeficiency Syndrome

Anniversaries tend to be occasions for reflection, for review of past accomplishments and disappointments, and for renewal of aspirations. Therefore, it is not surprising that approximately 10 years after the discovery that the human immunodeficiency virus (HIV) causes the acquired immunodeficiency syndrome (AIDS), much discussion of the progress made in AIDS research has taken place and many proposals to completely overhaul our approach to this problem have been made [1].

Clearly, this is not a time for celebration. That the progress made to date has been insufficient is plainly evident in most of our hospitals every day. The acquired immunodeficiency syndrome continues to take an unrelenting toll on our patients and our society; it is now the leading cause of death in the United States for men between the ages of 25 and 44 years, and will almost certainly achieve that unwelcome distinction for women of the same age by the end of the decade [2].

However, it is worth taking stock of where we were in 1984 to put into perspective what has been achieved and what still needs to be done. Patients with AIDS live longer in 1994 than they did in 1984—almost three times as long—and although the cause of this increased survival is not totally apparent, it is largely due to improved therapy and prevention of opportunistic processes [3]. In 1984, no antiretroviral drugs were available. In 1994, we have agents …