AIDS

Acquired Immunodeficiency Syndrome (AIDS), human viral disease that ravages the immune system, undermining the body’s ability to defend itself from infection and disease. Caused by the human immunodeficiency virus (HIV), AIDS leaves an infected person vulnerable to opportunistic infections. Such infections are harmless in healthy people, but in those whose immune systems have been greatly weakened, they can prove fatal. Although there is no cure for AIDS, new drugs are available that can prolong the life spans and improve the quality of life of infected people.

Infection with HIV does not necessarily mean that a person has AIDS. Some people who have HIV infection may not develop any of the clinical illnesses that define the full-blown disease of AIDS for ten years or more. Physicians prefer to use the term AIDS for cases where a person has reached the final, life-threatening stage of HIV infection.

AIDS was first identified in 1981 among homosexual men and intravenous drug users in New York and California. Shortly after its detection in the United States, evidence of AIDS epidemics grew among heterosexual men, women, and children in sub-Saharan Africa. AIDS quickly developed into a worldwide epidemic, affecting virtually every nation. By 2002 an estimated 38.6 million adults and 3.2 million children worldwide were living with HIV infection or AIDS. The World Health Organization (WHO), a specialized agency of the United Nations (UN), estimates that from 1981 to the end of 2002 about 20 million people died as a result of AIDS. About 4.5 million of those who died were children under the age of 15.

In the United States about 40,000 new HIV infections occur each year. More than 30 percent of these infections occur in women, and 60 percent occur in ethnic minorities. In 2001 more than 800,000 U.S. residents were infected with HIV, and more than 300,000 people were living with full-blown AIDS. In Canada about 4,200 new HIV infections occur each year. Nearly 25 percent of these infections occur in women. In 2002 about 55,000 Canadians were living with HIV infection and about 18,000 people were living with full-blown AIDS.

The incidence of new cases of HIV infections and AIDS deaths has significantly decreased in Canada and the United States since 1995. This decrease is attributed to the availability of new drug treatments and public health programs that target people most at risk for infection. But while the overall rate of HIV infection seems to be on a downturn, certain populations appear to be at greater risk for the disease. In the United States in 1987, Caucasians accounted for 60 percent of AIDS cases and blacks and Hispanics only 39 percent. But by 2000 the trend had reversed: 26 percent of new cases were diagnosed in Caucasians and 73 percent in blacks and Hispanics. Likewise the number of female AIDS patients in the United States has increased significantly in recent years, from 7 percent of all AIDS cases in 1985 to 30 percent in 2000. In the United States, African American and Hispanic women accounted for 82 percent of AIDS cases among women in 2000.

In western Europe the first cases of AIDS were detected in the early 1980s, and by the late 1990s, at least 30,000 new HIV infections occurred each year. In 2002 about 570,000 western Europeans were HIV positive, and 25 percent of these cases were women. Before the dissolution of the Union of Soviet Socialist Republics (USSR) in 1991, eastern Europe reported few HIV cases. But since 1995, HIV infection has spread rapidly in cities of several eastern European countries, including Ukraine, Belarus, and Moldova. The WHO estimates that the total number of HIV infections in this region may have risen from less than 30,000 in 1995 to about 1 million in 2002.

While cases of AIDS have been reported in every nation of the world, the disease affects some countries more than others. More than 95 percent of all HIV-infected people live in the developing world. In these areas, the disease has sapped the populations of young men and women who form the foundation of the labor force. Most die while in the peak of their reproductive years. Moreover, the epidemic has overwhelmed health-care systems, increased the number of orphans, and caused life expectancy rates to plummet. These problems have reached crisis proportions in some parts of the world already burdened by war, political upheaval, or unrelenting poverty.

Nowhere is this better demonstrated than in sub-Saharan Africa, where the number of AIDS cases far exceeds that of all other geographic regions. Of the estimated 14,000 HIV infections that occur each day worldwide, about half of these infections occur in sub-Saharan Africa. About 70 percent of all people infected with HIV live in this region. In some countries in the southern part of the continent, including Botswana, Lesotho, Swaziland, and Zimbabwe, more than 30 percent of the population has HIV infection or AIDS.

In Asia and the Pacific Islands an estimated 7.2 million people were living with HIV infection by 2002. Health officials fear that as the virus spreads through China and India, the world’s two most populous countries, cases of HIV infection in this region may surge up to 25 million cases by the year 2010, dwarfing the problems seen in sub-Saharan Africa.

In 2002 the Chinese government reported that China had about 1 million HIV-positive people in a population of more than 1 billion. However, public health experts are concerned by the fast-rising number of new infections among intravenous drug users who share infected needles. In 2000 HIV prevalence among intravenous drug users ranged from 44 percent to 85 percent in selected communities of drug users in both Yunnan, in southern China, and Xinjiang, in northwestern China. The incidence of HIV infection will likely be exacerbated by the growing sex industry in China. Surveys indicate that as many as 4 million prostitutes work in China. Of these, four out of ten never use a condom to protect themselves or their clients from HIV infection or other sexually transmitted infections. In rural areas of China the incidence of HIV infection is rising because many poverty-stricken people regularly sell their blood. The people who buy the blood use unsterile methods to draw blood, including reusing contaminated needles, which can spread HIV infection.

In Latin America and the Caribbean region nearly 1.7 million people have been diagnosed with HIV infection or AIDS, twice the incidence in the United States and Canada. Brazil, Mexico, Colombia, and Argentina are the Latin American countries with the highest number of cases of HIV infection or AIDS.

AIDS is the final stage of a chronic infection with the human immunodeficiency virus. There are two types of this virus: HIV-1, which is the primary cause of AIDS worldwide, and HIV-2, found mostly in West Africa. On its surface, HIV carries a protein structure that recognizes and binds only with a specific structure found on the outer surface of certain cells. HIV attacks any cell that has this binding structure. However, white blood cells of the immune system known as T cells, which orchestrate a wide variety of disease-fighting mechanisms, are especially vulnerable to HIV attack. Particularly vulnerable are certain T cells known as CD4 cells. When HIV infects a CD4 cell, it commandeers the genetic tools within the cell to manufacture new HIV virus. The newly formed HIV virus then leaves the cell, destroying the CD4 cell in the process. No existing medical treatment can completely eradicate HIV from the body once it has integrated into human cells.

The loss of CD4 cells endangers health because these immune cells help other types of immune cells respond to invading organisms. The average healthy person has over 1,000 CD4 cells per microliter of blood. In a person infected with HIV, the virus steadily destroys CD4 cells over a period of years, diminishing the cells’ protective ability and weakening the immune system. When the density of CD4 cells drops to 200 cells per microliter of blood, the infected person becomes vulnerable to any of about 26 opportunistic infections and rare cancers, which take advantage of the weakened immune defenses to cause disease.

Scientists have identified three ways that HIV infections spread: sexual intercourse with an infected person, contact with contaminated blood, and transmission from an infected mother to her child before or during birth or through breastfeeding.

HIV transmission occurs most commonly during intimate sexual contact with an infected person, including genital, anal, and oral sex. The virus is present in the infected person’s semen or vaginal fluids. During sexual intercourse, the virus gains access to the bloodstream of the uninfected person by passing through openings in the mucous membrane—the protective tissue layer that lines the mouth, vagina, and rectum—and through breaks in the skin of the penis. In the United States and Canada, HIV is most commonly transmitted during sex between homosexual men, but the incidence of HIV transmission between heterosexual men and women has rapidly increased. In most other parts of the world, HIV is most commonly transmitted through heterosexual sex.

Direct contact with HIV-infected blood occurs when people who use heroin or other injected drugs share hypodermic needles or syringes contaminated with infected blood. Sharing of contaminated needles among intravenous drug users is the primary cause of HIV infection in eastern Europe, particularly in Ukraine, Russia, Belarus, and Moldova. Epidemics of HIV infection among drug users have also emerged in Georgia, Armenia, Azerbaijan, and Kazakhstan in Central Asia.

Less frequently, HIV infection results when health professionals accidentally stick themselves with needles containing HIV-infected blood or expose an open cut to contaminated blood. Some cases of HIV transmission from transfusions of infected blood, blood components, and organ donations were reported in the 1980s. Since 1985 government regulations in the United States and Canada have required that all donated blood and body tissues be screened for the presence of HIV before being used in medical procedures. As a result of these regulations, HIV transmission caused by contaminated blood transfusion or organ donations is rare in North America. However, the problem continues to concern health officials in sub-Saharan Africa. Less than half of the 46 nations in this region have blood-screening policies. By some estimates only 25 percent of blood transfusions are screened for the presence of HIV. WHO hopes to establish blood safety programs in more than 80 percent of sub-Saharan countries by 2003.HIV can be transmitted from an infected mother to her baby while the baby is still in the woman’s uterus or, more commonly, during childbirth. The virus can also be transmitted through the mother’s breast milk during breastfeeding. Mother-to-child transmission accounts for 90 percent of all cases of AIDS in children. Mother-to-child transmission is particularly prevalent in Africa, where the number of women infected with HIV is ten times the rate found in other regions. Studies conducted in several cities in southern Africa in 1998 indicate that up to 45 percent of pregnant women in these cities carry HIV.

DMisperceptions About HIV Transmission

The routes of HIV transmission are well documented by scientists, but health officials continually grapple with the public’s unfounded fears concerning the potential for HIV transmission by other means. HIV differs from other infectious viruses in that it dies quickly if exposed to the environment. No evidence has linked HIV transmission to casual contact with an infected person, such as a handshake, hugging, or kissing, or even sharing dishes or bathroom facilities. Studies have been unable to identify HIV transmission from modes common to other infectious diseases, such as an insect bite or inhaling virus-infected droplets from an infected person’s sneeze or cough.

Without medical intervention, AIDS progresses along a typical course. Within one to three weeks after infection with HIV, most people experience flu-like symptoms, such as fever, sore throat, headache, skin rash, tender lymph nodes, and a vague feeling of discomfort. These symptoms last one to four weeks. During this phase, known as acute retroviral syndrome, HIV reproduces rapidly in the blood. The virus circulates in the blood throughout the body, particularly concentrating in organs of the lymphatic system.

The normal immune defenses against viral infections eventually activate to battle HIV in the body, reducing but not eliminating HIV in the blood. Infected individuals typically enter a prolonged asymptomatic phase, a symptom-free period that can last ten years or more. While persons who have HIV may remain in good health during this period, HIV continues to replicate, progressively destroying the immune system. Often an infected person remains unaware that he or she carries HIV and unknowingly transmits the virus to others during this phase of the infection.

When HIV infection reduces the number of CD4 cells to around 200 per microliter of blood, the infected individual enters an early symptomatic phase that may last a few months to several years. HIV-infected persons in this stage may experience a variety of symptoms that are not life-threatening but may be debilitating. These symptoms include extensive weight loss and fatigue (wasting syndrome), periodic fever, recurring diarrhea, and thrush, a fungal mouth infection. An early symptom of HIV infection in women is a recurring vaginal yeast infection. Unlike earlier stages of the disease, in this early symptomatic phase the symptoms that develop are severe enough to cause people to seek medical treatment. Many may first learn of their infection in this phase.

If CD4 cell levels drop below 200 cells per microliter of blood, the late symptomatic phase develops. This phase is characterized by the appearance of any of 26 opportunistic infections and rare cancers. The onset of these illnesses, sometimes referred to as AIDS-defining complications, is one sign that an HIV-infected person has developed full-blown AIDS. Without medical treatment, this stage may last from several months to years. The cumulative effects of these illnesses usually cause death.

Often the first opportunistic infection to develop is pneumocystis pneumonia, a lung infection caused by the fungus Pneumocystis carinii. This fungus infects most people in childhood, settling harmlessly in the lungs where it is prevented from causing disease by the immune system. But once the immune system becomes weakened, the fungus can block the lungs from delivering sufficient oxygen to the blood. The lack of oxygen leads to severe shortness of breath accompanied by fever and a dry cough.

In addition to pneumocystis pneumonia, people with AIDS often develop other fungal infections. Up to 23 percent of people with AIDS become infected with fungi from the genus Cryptococcus, which cause meningitis, inflammation of the membranes that surround the brain. Infection by the fungus Histoplasma capsulatum affects up to 10 percent of people with AIDS, causing general weight loss, fever, and respiratory complications.

Tuberculosis, a severe lung infection caused by the bacterium Mycobacterium tuberculosis, typically becomes more severe in AIDS patients than in those with a healthy immune system. Between the 1950s and the late 1980s, tuberculosis was practically eradicated in North America. In the early 1990s, doctors became alarmed when incidence of the disease dramatically escalated. This resurgence has been attributed to the increased susceptibility to tuberculosis of people infected with HIV. Infection by the bacterium Mycobacterium avium can cause fever, anemia, and diarrhea. Other bacterial infections of the gastrointestinal tract contribute to wasting syndrome.

Opportunistic infections caused by viruses, especially members of the herpesvirus family, are common in people with AIDS. One of the herpesviruses, cytomegalovirus (CMV), infects the retina of the eye and can result in blindness. Another herpesvirus, Epstein-Barr virus (EBV), may cause certain types of blood cancers. Infections with herpes simplex virus (HSV) types 1 or 2 may result in sores around the mouth, genital area, or anus.

Many people with AIDS develop cancers. The destruction of CD4 cells impairs the immune functions that halt the development of cancer. Kaposi’s sarcoma is a cancer of blood vessels caused by a herpesvirus. This cancer produces purple lesions on the skin, which can spread to internal organs and cause death. B cell lymphoma affects certain cells of the lymphatic system that fight infection and perform other vital functions. Cervical cancer is more common in HIV-infected women than in women free from infection.

A variety of neurological disorders are common in the later stage of AIDS. Collectively called HIV-associated dementia, they develop when HIV or another microbial organism infects the brain. The infection produces degeneration of intellectual processes such as memory and, sometimes, problems with movement and coordination.

HIV infection in children progresses more rapidly than in adults, most likely because the immune systems in children have not yet built up immunity to many infectious agents. The disease is particularly aggressive in infants—more than half of infants born with an HIV infection die before age two. Once a child is infected, the child’s undeveloped immune system cannot prevent the virus from multiplying quickly in the blood. This extensive virus burden speeds the progression of the disease. In contrast, when adults become infected with HIV, their immune system generally fights the infection. Therefore, HIV levels in adults remain lower for an extended period, delaying the progression of the disease.

Children develop many of the opportunistic infections that befall adults but also exhibit symptoms not observed in older patients. Among infants and children, HIV infection produces wasting syndrome and slows growth (generally referred to as failure to thrive). HIV typically infects a child’s brain early in the course of the disease, impairing intellectual development and coordination skills. While HIV can infect the brains of adults, it usually does so toward the later stages of the disease and produces different symptoms.

Children show a susceptibility to more bacterial and viral infections than adults. More than 20 percent of HIV-infected children develop serious, recurring bacterial infections, including meningitis and pneumonia. Some children suffer from repeated bouts of viral infections, such as chicken pox. Healthy children generally develop immunity to these viral illnesses after an initial infection.

VIDETECTING AND MONITORING HIV INFECTION

Since HIV was first identified as the cause of AIDS in 1983, a variety of tests have been developed that help diagnose HIV infection as well as determine how far the infection has progressed. Other tests can be used to screen donated blood, blood products, and body organs for the presence of HIV.

Doctors determine if HIV is present in the body by identifying HIV antibodies, specialized proteins created by the immune system to destroy HIV. The presence of the antibodies indicates HIV infection because these antibodies form in the body only when HIV is present. HIV antibodies form anywhere from five weeks to three months after HIV infection occurs, depending upon the individual’s immune system. The antibodies are produced continually throughout the course of the infection.

The standard test to detect HIV antibodies in the blood is the enzyme-linked immunosorbent assay (ELISA). In this test, a blood sample is mixed with proteins from HIV. If the blood contains HIV antibodies, they attach to the HIV proteins, producing a telltale color change in the mixture. This test is highly reliable when performed two to three months after infection with HIV. The test is less reliable when used in the very early stage of HIV infection, before detectable levels of antibodies have had a chance to form. Doctors routinely confirm a positive result from an ELISA test by using the Western Blot test, which can detect lower levels of HIV antibodies. In this test a blood sample is applied to a paper strip containing HIV proteins. If HIV antibodies are present in the blood, they bind to the HIV proteins, producing a color change on the paper. The combination of the ELISA and the Western Blot test is more than 99.9 percent accurate in detecting HIV infection within 12 weeks following exposure.

Once tests confirm an HIV infection, doctors monitor the health of the infected person’s immune system by periodically measuring CD4 cell counts in the blood. The progressive loss of CD4 cells corresponds to a worsening of the disease as the immune system becomes increasingly impaired. Doctors also measure the viral load—the amount of the virus in the blood—using polymerase chain reaction (PCR) technology. PCR tests measure the level of viral ribonucleic acid (RNA), a type of nucleic acid, in blood to determine the rate of HIV growth in an infected person. Knowing the viral load helps doctors estimate an infected person’s survival time. For example, studies show that without treatment, the average survival time for people with an HIV viral load greater than 30,000 per microliter of blood is 4.4 years, while those with a viral load below 10,000 per microliter of blood live for an average of ten years.

A modified ELISA test that detects p24 antigen, a protein produced by HIV, can determine if specific drug treatments are having a positive effect on a patient. Blood banks, plasma centers, clinical laboratories, private clinics, and public health departments also use this p24 antigen test to screen for the presence of HIV in blood, blood components, and organs before they are used in medical procedures.

Physicians prefer to differentiate between people who have HIV infection and those who have AIDS. The Centers for Disease Control and Prevention (CDC), based in Atlanta, Georgia, recommends that physicians reserve the diagnosis of AIDS for HIV-infected individuals whose CD4 count falls below 200 cells per microliter of blood. A diagnosis of AIDS can also be made without confirmation of CD4 levels if someone who has no other reason for immune system damage develops an opportunistic disease.

While no medical treatment cures AIDS, in the relatively short time since the disease was first recognized, new methods to treat the disease have developed rapidly. Health-care professionals focus on three areas of therapy for people living with HIV infection or AIDS: antiretroviral therapy using drugs that suppress HIV replication; medications and other treatments that fight the opportunistic infections and cancers that commonly accompany HIV infection; and support mechanisms that help people deal with the emotional repercussions as well as the practical considerations of living with a disabling, potentially fatal disease.

Understanding the specific steps in the HIV replication cycle is critical in order for scientists to develop drugs that attack vulnerable stages within the cycle. HIV belongs to a unique group of viruses known as retroviruses, so named because these viruses reverse the usual flow of genetic information within an infected cell. Most viruses store their genetic material in deoxyribonucleic acid (DNA), the double-helix structure that makes up genes. When a virus infects a cell, the viral DNA forms the template for the creation of messenger RNA, a type of ribonucleic acid. This messenger RNA directs the formation of specific proteins, and these proteins, in turn, build new virus particles (see Genetics). In HIV, however, genetic material is stored in two single-stranded RNA molecules. When HIV infects a cell, an enzyme called reverse transcriptase copies the genetic instructions in the virus’s RNA and moves it into the DNA. This movement of genetic information from RNA to DNA is the opposite of that which occurs in most cells during protein synthesis.

Another HIV enzyme, called integrase, helps the newly formed viral DNA to become part of the structure of the infected cell’s DNA. The viral DNA then forces the infected cell to manufacture HIV particles. A third HIV enzyme, called protease, packages these HIV particles into a complete and functional HIV virus. Over the last decade researchers have created a variety of drugs that block the action of some of the enzymes used in HIV replication. The three main classes of drugs used against HIV are nucleoside analogues, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors.

Nucleoside analogues impede the action of reverse transcriptase, the HIV enzyme that converts the virus’s genetic material into DNA. During this conversion process, these drugs incorporate themselves into the structure of the viral DNA, rendering the DNA useless and preventing it from instructing the infected cell to make additional HIV. The nucleoside analogue known as azidothymidine (AZT), which became available in 1987, was the first drug approved by the United States Food and Drug Administration (FDA) to treat AIDS. AZT slows HIV growth in the body, permitting an increase in the number of CD4 cells, which boosts the immune system. AZT also prevents transmission of HIV from an infected mother to her newborn. Since the introduction of AZT, additional nucleoside analogues have been developed, including didanosine (sold under the trade name Videx), zalcitabine (HIVID), stavudine (Zerit), lamivudine (Epivir), and abacavir (Ziagen). These drugs are not particularly powerful when used alone, and often their benefits last for only 6 to 12 months. But when nucleoside analogues are used in combination with each other, they provide longer-lasting and more effective results.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs), introduced in 1996, use a different mechanism to block reverse transcriptase. These drugs bind directly to reverse transcriptase, preventing the enzyme from converting RNA to DNA. Three NNRTIs are available: nevirapine (Viramune), delavirdine (Rescriptor), and efavirenz (Sustiva). NNRTIs work best when used in combination with nucleoside analogues.

The third group of antiviral drugs, called protease inhibitors, cripples protease, the enzyme vital to the formation of new HIV. When these drugs block protease, defective HIV forms that is unable to infect new cells. Protease inhibitors are more powerful than nucleosides and NNRTIs, producing dramatic decreases in HIV levels in the blood. This reduced viral load, in turn, enables CD4 cell levels to skyrocket. The first protease inhibitor, saquinavir (Invirase), was approved in 1995. Since then other protease inhibitors have been approved, including ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), and amprenavir (Agenerase).

Clinical studies of treatment with antiretroviral drugs immediately showed that their benefits are short-lived when a single drug is used alone. This short-term effectiveness results when HIV mutates, or changes its genetic structure, becoming resistant to the drug. The genetic material in HIV provides instructions for the manufacture of critical enzymes needed to replicate the virus. Scientists design current antiretroviral drugs to impede the activity of these enzymes. If the virus mutates, the structure of the virus’s enzymes changes. Drugs no longer work against the enzymes, making the drugs ineffective against viral infection.

Genes mutate during the course of viral replication, so the best way to prevent mutation is to halt replication. Studies have shown that the most effective treatment to halt HIV replication employs a combination of three drugs taken together—for instance, a combination of two nucleoside analogues with a protease inhibitor. This regimen, called triple therapy, maximizes drug potency while reducing the chance for drug resistance. The combination of three drugs is often referred to as an AIDS cocktail. In HIV-infected patients who have undergone triple therapy, the viral loads reduced significantly, sometimes to undetectable levels. Their CD4 cell count gradually increased, and they sustained good health with no complications. With this treatment, some patients who were near death were able to return to work and normal physical activity. Triple therapy was introduced in the United States in 1996. That year AIDS deaths in the United States decreased 26 percent, the first decrease since the beginning of the epidemic. In 1997 U.S. AIDS deaths decreased by 56 percent from the year before.

Despite phenomenal success, triple therapy has some drawbacks. This multidrug therapy is quite complicated, requiring patients to take anywhere from 5 to 20 pills a day on a specific schedule. Some drugs must be taken with food, while others cannot be taken at the same time as certain other pills. Even the most organized people find it difficult to take pills correctly. Yet, just one or two lapses in treatment may cause the virus to develop resistance to the drug regimen.

Many people also find it difficult to deal with the unpleasant side effects produced by antiretroviral drugs. Common side effects include nausea, diarrhea, headache, fatigue, abdominal pain, kidney stones, anemia, and tingling or numbness in the hands and feet. Some patients may develop diabetes mellitus, while other patients develop collections of fat deposits in the abdomen or back, causing a noticeable change in body configuration. Some antiretroviral drugs produce an increase in blood fat levels, placing a patient at risk for heart attack or stroke. Some patients suffer more misery from the drug treatment than they do from the illnesses produced by HIV infection.

Perhaps the greatest drawback to triple therapy is its cost, which ranges from $10,000 to $12,000 a year. This high cost is well beyond the means of people with low incomes or those with limited health-care insurance. As a result, the most effective therapies currently available remain beyond the reach of the majority of HIV-infected people worldwide.

To decrease the toxic effects of drugs and to defer costly therapy, in 2001 United States federal health officials recommended delaying drug treatment for HIV infection in people showing no symptoms and who have been infected with HIV for more than six months. The new guidelines call for delaying treatment until an infected person’s CD4 cells fall below 350 cells per microliter of blood or the HIV viral load exceeds 30,000 per microliter of blood. Evidence suggests that delaying treatment poses no harm to infected people and, in fact, benefits them by deferring the toxic side effects of the drugs.

Studies show that under certain circumstances, administering antiretroviral drugs within 24 hours (preferably within one to two hours) after exposure to HIV can protect a person from becoming infected with the virus. Although the effectiveness of postexposure antiretroviral therapy following sexual exposure to HIV remains uncertain, the CDC recommends that health-care personnel exposed to HIV infection from a needle stick or other accident take antiretroviral drugs.

Scientists continue to develop more powerful HIV treatments that have fewer side effects and fewer resistance problems. Some drugs under investigation block the HIV enzyme integrase from inserting viral DNA into the infected cell. Other drugs prevent HIV from binding with a CD4 cell in the first place, thereby barring HIV entry into cells.

Some scientists focus on ways to fortify the immune system. A biological molecule called interleukin-2 shows promise in boosting the immune system’s arsenal of infection-fighting cells. Interleukin-2 stimulates the production o