Immunoprophylaxis of atopy: light at the end of the tunnel?

Current research in the field of atopy is directed almost exclusively towards treatment of established allergic disease. In particular, treatment has concentrated on controlling the release and actions of various mediators, such as cytokines, from the allergy effector cells at the end of the immunoinflammatory cascade. Here, Patrick Holt argues that a potentially more-effective and achievable goal may be the prevention of initial T helper 2 (Th2)-cell sensitization to environmental allergens during infancy. This might be achieved via amplification of the endogenous ‘immune deviation’ mechanism(s) that normally facilitate discrimination between pathogenic and non-pathogenic antigens at the mucosal surfaces of the body.     

Is AIDS vaccine research at a turning point?

Although initial anti-ENV vaccines have failed, better results may be obtained with "non-ENV" vaccines capable of inducing cell-mediated responses and perhaps mucosal reactions. A turning point in AIDS vaccine research has been reached in that there are three precise questions to answer: 1. Are the protections obtained in monkeys significant and reproducible and could they be made more frequent? 2. Can more frequent, polyepitopic, and long-lasting cell-mediated responses in human subjects be obtained? 3. Is it possible to induce significant mucosal responses? The decision as to whether phase III trials must be launched will depend on answers to these questions. It may be possible to organize international AIDS vaccine research so that these answers could be obtained in 3 to 4 years, but this would require a frank acceleration of the present endeavors.     

Decisions at the end of life: have we come of age?

Decision making is a complex process and it is particularly challenging to make decisions with, or for, patients who are near the end of their life. Some of those challenges will not be resolved - due to our human inability to foresee the future precisely and the human proclivity to change stated preferences when faced with reality. Other challenges of the decision-making process are manageable. This commentary offers a set of approaches which may lead to progress in this field.     

Assessment of ovarian reserve: is there still a role for ovarian biopsy in the light of new data?

Ovarian reserve depends on the number of primordial follicles in the ovarian cortex. It was suggested that determining the follicular density directly by obtaining ovarian biopsy might be more accurate than current indirect biochemical and ultrasonic tests, especially for women in the later stage of their reproductive life. It might also be important and beneficial for young patients having chemotherapy for malignant disease in whom the ovarian tissue should be considered for reimplantation after recovery. The advantages and pitfalls of obtaining ovarian biopsy in these cases are discussed in light of new emerging data on the natural distribution of primordial follicles in the human ovary and its implications.     

Treatment and care for HIV / AIDS: is there hope for the developing world?

Although 92% of the estimated 21 million adults and children infected with human immunodeficiency virus (HIV) live in developing countries, only 8% of global spending on acquired immunodeficiency syndrome (AIDS) supports programs in resource-poor countries in Africa, Asia, and Latin America. AIDS treatment and care in the developing world were addressed at a meeting held in Washington, D.C., on October 7, 1996, sponsored by the National Council for International Health's AIDS Program and the Global Network of People with AIDS. It was noted that most people with AIDS in the Third World lack access to treatment for opportunistic infections, let alone the new combination drug therapies that have led those in developed countries to declare a "near victory" over AIDS. Since the international donor community has been slow to discern its role in AIDS treatment, private individuals and groups have taken the initiative to send medical supplies and unused or expired drugs to Asia and Latin America. Although such medication banks fulfill a short-term need, they do not address the overall problem of inequitable access to care and treatment. The Global Network seeks to gain support from donor organizations for training programs in treatment and care skills building, including training for physicians in developing countries, improved information sharing, counseling to people with AIDS, programs for treatment advocates, and global strategies to improve access to medications. Also envisioned was the formation of medical cooperatives that work in coordination with recipient countries and operate within the context of legal parameters.