In the early days of the epidemic, a diagnosis of HIV was a death sentence. The disease would eventually progress to AIDS, allowing any number of infections to attack the body. Doctors watched helplessly as the disease destroyed immune systems and killed the patient. Palliative care was the most that they could offer.

Top 10 research advances

1. In the 1980s, French and American researchers developed an antibody test for HIV, which is now used to test individuals and blood banks.

2. Latex condoms, according to a 1987 study, are a highly effective means of preventing HIV transmission during sexual intercourse.

3. AZT was the first drug designed to combat AIDS, approved in 1987. Prior to its use, AIDS patients died soon after exhibiting their first symptoms.

4. The discovery in the '90s of protease inhibitors, drugs that reduce the viral load in the bloodstream, led to the introduction of a more effective drug regimen commonly known as triple cocktail therapy.

5. Research efforts have identified ways to prevent mother-to-child transmission, such as caesarean sections and use of formula instead of breast milk. These actions can reduce the risk of transmission from 50 per cent to less than one per cent.

6. Reverse transcriptase PCR is a technique that can quantify the viral load in people with HIV. This knowledge can help in selecting treatment.

7. Microbicides are creams, films, gels or suppositories that can prevent the transmission of HIV when applied topically before intercourse. Microbicides allow women to protect themselves and their partners in situations where condom use isn't readily accepted.

8. Drugs developed to fight infections in AIDS patients are being used to treat patients suffering from other forms of immune suppression. This research has also laid the foundation for the development of a cervical cancer vaccine.

9. In the past 20 years, more than 30 candidate HIV vaccines have been tested. A vaccine remains the best hope for halting the spread of AIDS.

10. There is a so-called ripple effect in AIDS research, where drugs can satisfy different needs. For example, drugs developed for dementia can treat patients with AIDS and those with Alzheimer's disease.

At first, doctors didn't even know what was causing the combination of symptoms they were seeing. It was originally called GRID, or Gay-Related Immune Deficiency, because it initially appeared in the gay community. It was two years after the first patients were seen that French scientists identified the virus causing AIDS.

But what they found out wasn't comforting. HIV is a retrovirus, carrying its genetic material in the form of RNA. It then transforms itself into a form of DNA, inserted into host cells. HIV destroys the body's immune system cells, leaving it open to infections. The virus is highly adaptable, making it difficult to fight. Patients with advanced HIV and AIDS are susceptible to a host of diseases, including tuberculosis, pneumonias, gastric illnesses, malignant cancers, and dementias.

For the first ten years after the disease was identified, there were no proven treatments to be had.

HAART keeps disease at bay

Then came 1996 and highly-active antiretroviral therapy, or HAART. The results of the research proving HAART's effectiveness were met with jubilation and tears at the International AIDS Conference in Vancouver that year.

The treatment is a combination of drugs that keeps the disease at bay in many people. Different drugs work on different aspects of the virus's replication process. But different combinations also have different effects on patients.

Side effects are also unpleasant. Many of the protease inhibitors affect people's ability to digest, and cause muscle soreness and loss of sensation in fingers and toes. Many HIV/AIDS patients lose body fat, giving them a shrunken, wasted look, even if they are healthy otherwise. Some people do very well on HAART, some don't. Doctors are still not sure why.

In North America, many now see HIV/AIDS as a manageable disease, thanks to HAART. If patients take their medicine as prescribed, many live with the disease for decades.

However, the therapy is complicated, requiring several pills, sometimes at different times of the day. Many people develop resistant strains as a result of not taking the medicine properly.

In July 2006, the U.S. Food and Drug Administration announced approval of an all-in-one pill for HAART. Researchers and doctors are hoping that a simplified pill schedule will mean more people will be able to stick to it.

In the developed world, HAART has changed the way people look at HIV and AIDS. The death sentence commuted, people can now look forward to years of life. How many years is still unclear, since these drugs have only been available for ten years.

Developing world desperate for treatment

In the developing world, AIDS treatment is not only a medical issue, but a political one. The drugs are expensive, and the epidemic in Africa is raging. Although some generic drugs are available, there aren't enough, and most who need them don't get them.

A large part of the problem is the stigma attached to the disease on the continent. Those who admit to being HIV positive are ostracized, and many won't seek treatment for that reason. Many have a suspicion of Western medicine, and have turned to traditional healers. Education programs and medical clinics are drastically underfunded.

AIDS activists have criticized government leaders for not doing enough. South African president Thabo Mbeki came under fire in 2000 when he said that HIV was not the cause of AIDS. His health minister has advised changes to nutrition to fight the disease, and suggested that antiretrovirals could be dangerous.

But UNAIDS reports that some countries are starting to turn around. In the most affected region, sub-Saharan Africa, infection rates seem to be levelling off. Rates in Kenya and Zimbabwe have actually gone down.

No vaccine in sight

Given the amount of money raised and spent on AIDS research in the last quarter century, many people expected a cure or a vaccine by now. But finding a cure for such a quickly mutating virus is no easy task. As well, HIV doesn't affect animals in the same way as humans, so animal testing in the early stages is difficult.

Attempts to produce a vaccine have been frustrating. According to the International AIDS Vaccine Initiative, there are more than 30 vaccines in the early stages of human clinical trials. Results are due in late 2007. However, the IAVI says most of those vaccines work the same way. If the method proves ineffective, it's back to the drawing board.

One hope is from HIV positive patients known as "long-term nonprogressors." These are people who have been infected with the virus, but show no increase of the virus in their system for years, without taking any medicine at all. There is also a small proportion of people who have been exposed to HIV, but not been infected. Researchers still have no idea why the disease seems to affect these people differently, but the hunt is on to find out.

Protests shut down drug trials

Drug trials have also met with resistance. Take the example of Tenofovir, which is being tested as a so-called "chemical vaccine."

The drug is currently used to slow the progression of the disease in those already infected. But researchers are holding trials to determine whether it could also prevent infection in high-risk populations. It doesn't work like traditional vaccines, which teach the immune system to develop resistance to viruses or bacteria. Tenofovir must be taken daily, and is effective only for hours or days.

Researchers decided on clinical trials in high-risk populations in Cambodia and Thailand, in order to get faster results. But in both countries, the trials faced dramatic opposition

Protesters demanded greater support for sex workers who were the trial subjects, and accused the researchers of ulterior motives. They wondered why the trials weren't being held in the U.S., despite the fact that Tenofovir is already regularly used there. The trials were shut down. Tests are now being conducted in Ghana, Malawi, Botswana and Peru.

Prevention the best defence

Some researchers have also started giving antiretrovirals to those who are still HIV negative, but at high risk of getting the virus, in hopes that it will prevent infection or slow disease progression. Pregnant mothers who are HIV-positive can receive treatment to reduce the chances of passing the disease on to their children.

But for now, the best offence may be a good defence: condoms, clean needles, abstinence and avoiding risky behaviour are the best ways to stay HIV-negative.

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