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Perspectives in Biology and Medicine 47.2 (2004) 305-308
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Over the 20-plus years since acquired immunodeficiency syndrome (AIDS) was recognized and defined, and the 18 years since the germ responsible for the syndrome was first discovered, an unprecedented effort to understand HIV and the disease it causes has resulted in rapid advances in virology and immunology. A new field, antiretroviral chemotherapy, has been launched, with the development of a vast array of drugs directed at specific viral targets. Other areas of therapeutics, such as vaccinology and immunotherapeutics, have also advanced [End Page 305] in the effort to vanquish HIV.These treatments have, in turn, led to the emergence of drug resistance, which has driven yet more drug discovery and the study of drug resistance. The emergence of resistance itself appears to result from a complex interaction of socioeconomic, behavioral, pharmacologic, and viral factors, and has resulted in another area of clinical research, that of medical adherence. The necessity for such a frantic pace of discovery has been driven by a worldwide pandemic that continues to accelerate, resulting in the death of millions annually and the disintegration of the societies most affected.
Never has progress in the understanding and treatment of any disease moved at such a rapid pace, to span so many disciplines in so short a time. It is simply impossible for someone new to the field to gain an understanding of HIV medicine without a jump-start. In fact, it is difficult for someone with clinical expertise in HIV medicine to understand the basic virology, and vice versa. This book attempts to provide a bridge for those scientists who wish to get up to speed in their knowledge of HIV virology and therapeutics. It is a compilation by a diverse group of authors, each of whom has written a chapter on an area in which they are recognized experts. As with any book written in this way, there is considerable variation in the style and depth of the different chapters. Dr. Emilio Emini states in the introduction that the chapters are meant to stand alone, and that the information contained in earlier chapters is not prerequisite for subsequent ones. This design works well: as the reviewer, I can attest to the fact that reading this book cover to cover is not for the faint of heart. Having said that, however, most chapters were written so that someone with a background in biology or medicine could follow and understand from start to finish. Others required a fairly detailed understanding of nucleic acid biochemistry.
The book begins with a chapter describing the basic structural biology of the virus and is an excellent review of this subject, complete with illustrations. It is followed by a chapter on HIV genetics. This chapter was a group effort, and unfortunately it appears to have been written without the benefit of seeing the first chapter, because it reiterates much of what had already been said. However, the chapter is redeemed by a discussion of viral diversity and evolution. This subject can be viewed from the perspective of a single infected person, as well as from population and global perspectives. Viral diversity is a key component to understanding the HIV pandemic, barriers to treatment, and the development of long-lasting immunity. For example, anyone who acquires HIV infection begins with a single or few genetically distinct viruses, so that for the most part, the virus grows as a clone of the original infecting organism(s). Due to HIV's high replication rate and a highly error-prone reverse transcription process, over a fairly short period of time (only days in some instances), the virus can rapidly evolve within each infected person into multiple genetically diverse pseudotypes, adapting to any and every selection pressure we can throw at them—this is natural selection at light speed. These selection pressures initially [End Page 306] include the immune response, as well as the number and...