The battle against AIDS
A 20-year progress report
It was 20 years ago that AIDS was first diagnosed in a group of San Francisco Bay-area men who had developed a variety of unusual cancers and infections. The rapid spread of the disease — and the discovery that it is caused by the human immunodeficiency virus (HIV-1) — spurred a vast expansion of research into viral diseases and the body's defenses against them. The research has revolutionized scientists' understanding of the immune system and has led to the development of new drugs that have literally rescued patients from their deathbeds and given tens of thousands of infected individuals a chance to prolong their lives.
But no one is declaring victory in the war on AIDS. The existing drugs are expensive — far too expensive for the millions of HIV-infected people in developing countries — can cause intolerable side effects, and may lose their potency as HIV-1 evolves into new strains. The best hope, most scientists agree, is a vaccine that can prevent people from becoming infected. While many AIDS vaccines are currently in development, most scientists believe an effective one is still years away.
Dana-Farber has been a leader in AIDS research from the start of the epidemic. By a unique turn of fortune, the Institute had opened a brand-new suite of laboratories in 1981, specifically designed for the study of highly infectious agents such as HIV. The Institute has been home to many key discoveries about HIV-1 and the immune system over the 20 years since then. To learn about some of those discoveries, and assess where AIDS research is headed, Paths of Progress spoke with Joseph Sodroski, MD, who directs the Center for AIDS Research at Dana-Farber, Beth Israel Deaconess Medical Center, and Children's Hospital Boston, a consortium that includes several hundred investigators and staff.
How and when did Dana-Farber get involved in AIDS research?
Dana-Farber Cancer Institute has long had strong programs in viral research, particularly into human and animal retroviruses such as those that give rise to AIDS. Immunology is another of the Institute's long-time strengths. In the early 1980s, when AIDS was recognized, DFCI scientists were well-equipped to study its viral origin and effects on the immune system.
What are some of the major advances against AIDS that originated in Dana-Farber laboratories?
The list of AIDS research accomplishments by DFCI researchers begins in the earliest days of the epidemic, in 1980 to 1984, and continues to the present.
Dana-Farber scientists were among the first to show that AIDS resulted from the loss of a particular kind of blood cell called a CD4+ T lymphocyte. Later work in animals showed that HIV-1, the cause of AIDS, infects these cells and kills them by a process involving proteins from the virus' outer envelope. The details of these proteins and the structures by which the virus "docks with" and enters blood cells were identified by teams that included DFCI researchers.
Joseph Sodroski, MD
Many of the discoveries about the DNA pattern within HIV-1 and the novel genes in the virus were made by Dana-Farber scientists.
The idea of using drugs after exposure to HIV-1 to stop infection was first developed at the Institute. Studies here also led to some of the most promising techniques for preventing mother-to-infant transmission of HIV-1.
Dana-Farber scientists developed ways of studying AIDS in animals that will help determine which AIDS vaccines are most likely to be effective in humans.
In a related area, researchers at DFCI first showed that HIV-1-like viruses had advantages over some other viruses for delivering genes to human blood cells, a discovery that may be useful for fine-tuning gene therapy for many conditions.
What are the most promising avenues of AIDS research at the Institute today, and what aspects of the AIDS puzzle is Dana-Farber well-positioned to attack?
The work of several DFCI laboratories has the potential to strengthen the immune system's response to HIV-1, thereby impeding the transmission and spread of the virus. These responses include antibodies that block HIV-1 infection and killer cells that clear virus-infected cells from the body. Such responses will be needed for an effective vaccine.
Institute scientists also are well-positioned to devise drugs capable of blocking HIV-1's reproduction in the body. New drugs will be needed for the treatment of HIV-1 infection, particularly as viruses that are resistant to current drugs become more prevalent.
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