HIV/AIDS epidemiology, pathogenesis, prevention, and treatment

Abstract

The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world, and is undoubtedly the defining public-health crisis of our time. Research has deepened our understanding of how the virus replicates, manipulates, and hides in an infected person. Although our understanding of pathogenesis and transmission dynamics has become more nuanced and prevention options have expanded, a cure or protective vaccine remains elusive. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings. This transformation has yet to be realised in those parts of the world that continue to bear a disproportionate burden of new HIV-1 infections and are most a % ected by increasing morbidity and mortality. This Seminar provides an update on epidemiology, pathogenesis, treatment, and prevention interventions pertinent to HIV-1. HIV pandemicAn estimated 38·6 (33·4-46·0) million people live with HIV-1 worldwide, while about 25 million have died already. 1 In 2005 alone, there were 4·1 million new HIV-1 infections and 2·8 million AIDS deaths. 1 These estimates mask the dynamic nature of this evolving epidemic in relation to temporal changes, geographic distribution, magnitude, viral diversity, and mode of transmission. Today, there is no region of the world untouched by this pandemic (figure 1). 2 Heterosexual transmission remains the dominant mode of transmission and accounts for about 85% of all HIV-1 infections. Southern Africa remains the epicentre of the pandemic and continues to have high rates of new HIV-1 infections. 3 Although overall HIV-1 prevalence remains low in the emerging epidemics in China and India, the absolute numbers, which are fast approaching those seen in southern Africa, are of concern. 1 Outside of sub-Saharan Africa, a third of all HIV-1 infections are acquired through injecting drug use, most (an estimated 8·8 million) of which are in eastern Europe and central and southeast Asia. 1 The rapid spread of HIV-1 in these regions through injecting drug use is of importance, since it is a bridge for rapid establishment of more generalised epidemics. NIH-PA Author ManuscriptA defining feature of the pandemic in the current decade is the increasing burden of HIV-1 infections in women, 4 which has additional implications for mother-to-child transmission. Women now make up about 42% of those infected worldwide; over 70% of whom live in sub-Saharan Africa. 1 Overall, a quarter of all new HIV-1 infections are in adults aged younger than 25 years. 1 HIV-1 infection rates are three to six times higher in female adolescents than in their male counterparts, 1,5-7 and this difference is attributed to sexual coupling patterns of young women with older men. Population prevalence of HIV-1 infection, concurrent sexual relationships, partner change, sexual practices, the presence of other sexually transmitted diseases, [8][9][10][11] and population mobility patterns 12-14 for economic and other reasons (eg, natu...

HIV and prostate cancer: a systematic review of the literature

“…This is most commonly referred to as HAART; the synergistic use of several medications aimed at preventing viral replication, incorporation into host DNA, cleavage of a precursor polyprotein into active viral proteins and inhibition of fusion of the viral envelope into host cells. 39 These therapies have transformed AIDS from an inevitably fatal condition to a chronic, manageable disease. Furthermore, HAART has been demonstrated to reduce the incidence of Kaposi sarcoma and non-Hodgkin lymphoma.…”

The WHO Clinical Staging System for HIV/AIDS

“…In areas with adequate resources, laboratory measurements of CD4+ T cells and plasma HIV viral load are commonly used to establish a patient's degree of immunosuppression and the rate of destruction of the immune system [3]. These tools are used to ascertain a patient's eligibility for treatment and to monitor disease progression.…”

“…Several discrete clinical phases can be recognized along the continuum, and they correlate with the degree of immunodeficiency that arises with progression of HIV infection. Early identification and treatment is crucial to reduce transmission of the virus, but many people remain unaware of their HIV status during the crucial early months of infection when transmission risk is high, secondary to elevated levels of viremia [3]. Monitoring systems that do not rely on laboratory techniques are also needed in resource-limited settings to monitor the increasing numbers of patients on antiretroviral medications [9].…”

Patrones de prescripción de antirretrovirales en 997 pacientes colombianos

“…Desde el inicio de la pandemia de VIH-sida han muerto, aproximadamente, 13,9 millones de personas debido a esta infección (5).…”