A Holy Grail for HIV

About 12 years after the discovery of the human immunodeficiency virus (HIV) as the cause of AIDS, combination antiretroviral therapy made its grand debut in the mid-1990s. These miracle drugs fundamentally altered the natural history of AIDS, transforming a disease that carried an almost certain death sentence into a chronically manageable condition. But many would falsely conclude that the threat of HIV/AIDS is over.

While progress has been great, it is important to remember that millions of infected people remain untreated. Antiretroviral drugs immensely improve the quality and quantity of life for most infected people, but these drugs are not curative—they must be taken every day for life. New approaches are urgently needed, as outlined in “An Endgame for an Epidemic” (Fall 2018).

An effective HIV vaccine has long been regarded as the holy grail of HIV research. In contrast to many pathogens, progress toward an HIV vaccine has been haltingly slow. One limiting factor is that the key types of immunologic responses required for protection remain poorly defined. It is too early to predict which vaccine approach will ultimately cut this current Gordian knot, but it is imperative that a broad-based search be undertaken.

Warner C. Greene // Director, Gladstone Center for HIV Cure Research, Gladstone Institutes, San Francisco, Calif.

Medicine in Deep Space

“140 Million Miles From Home” (Fall 2018) provides a succinct survey of physiological and psychological challenges men and women will face on a space mission to Mars. It also addresses some of the currently available and newly emerging strategies and countermeasures to mitigate biomedical risks associated with long-duration human spaceflight.

Prolonged effects of reduced gravity, solar radiation, isolation, confinement and distance from the Earth are all stressors to human health. Risk is inevitable and solutions are needed to ensure crew safety and health, as well as mission success.

Gazing forward, astronauts venturing beyond low-Earth orbit for extended periods of time will require capabilities that—compared with the systems and approaches utilized today aboard the International Space Station—are more compact, integrated and sustainable, and allow for increased autonomy and personalization to that astronaut. In preparing for innovations that define the future, space biomedical research will benefit enormously from advances in science, medicine and engineering. Reciprocally, ambitious human space endeavors will drive discovery, inspire humanity and yield benefits that enhance life on Earth.

Jeffrey P. Sutton // Founding Director, Center for Space Medicine, Baylor College of Medicine, Houston, Texas