These days, it's common for HIVers to receive lab tests to predict how their particular strain of virus will react to various medications to determine potential drug resistance, allergic reactions, and so on. But imagine if a genetic screen could instruct a medical team how best to train your immune system to fight the virus on its own, possibly without the need for daily antiretrovirals.

The study of such gene therapies, currently in its infancy, has the theoretical potential to revolutionize HIV care in the next five to 15 years-at least in countries that can afford what may be a hefty expense. At minimum, gene therapy could prove a hearty partner to highly active antiretroviral therapy, perhaps better suppressing viral loads, lessening pill burdens, or allowing for structured treatment interruptions. Standing in the way of such progress, though, are the vast unknowns of the new field.

“We need to be better than nature,” says Nobel laureate David Baltimore, MD, a professor of biology at the California Institute of Technology. Baltimore is attempting to manufacture synthetic antibodies that can fight HIV in a way that ordinary human antibodies have failed to.

While the pipeline for new anti-HIV meds has hit a dry patch -- no major new drug is expected to be approved in the next couple of years -- a handful of small biotech companies and intrepid academics, such as Baltimore, are stirring a genetic wave for the future.

“In light of all the issues around antiretroviral therapy -- with costs, with unknown side effects, with the difficulties of adherence, all those things -- an approach like gene therapy is really exciting,” says Matt Sharp, director of treatment and prevention advocacy at Project Inform in San Francisco. “The field is clearly moving forward, albeit slowly.”

“Anything that could get people off antiretrovirals, even just for an extended period, could be a huge thing,” seconds Richard Jefferys, a treatment advocate with Treatment Action Group.