In the United States and other developed countries, the numbers of new AIDS diagnoses and deaths have fallen substantially during the past three years. This trend is due to several factors, including improved prophylaxis against opportunistic infections and improved treatment, the growing experience among health professionals in caring for HIV-infected patients, improved access to health care, and the decrease in the number of new HIV infections due to prevention efforts. However, the most influential factor has clearly been the increased use of potent anti-HIV drugs, generally administered in combinations of three or more agents and usually including a protease inhibitor.

Sixteen anti-HIV drugs are now licensed by the Food and Drug Administration. These drugs have had dramatic effects in reversing the extent of illness in many patients with advanced disease, as well as in preventing the progression of disease in those who are relatively healthy.

The use of antiretroviral drugs in pregnant women with HIV infection and their infants is an extraordinarily successful prevention strategy. The rate of mother-to-child transmission of HIV in the US has been cut to negligible levels among women and infants treated with an extended regimen of zidovudine therapy.

The HIV pandemic has posed a formidable challenge to the biomedical-research and public health communities of the world. Dr. Fauci states, "Minimizing the destructive impact of this epidemic will require partnerships between the public and private sectors as well as a stronger political will among the nations of the world. Unless methods of prevention, with or without a vaccine, are successful, the worst of the global pandemic will occur in the 21st century."

(Fauci A. The AIDS epidemic: considerations for the 21st century. N Engl J Med, 1999, 341(14):1046-1049)

COMMENT: It would please us to think that health education in the schools has helped reduce new cases of HIV in young adults. Now is not the time to slacken our efforts. - R.A.