Overview of the HIV/AIDS pandemic
Since the first cases of HIV/AIDS were reported in 1980 and identified in 1983, there have been extraordinary advances in our knowledge and treatment of this virus. HIV testing became available in 1985, which was important for protecting the blood supply, and in 1987 the first antiretroviral drug (azidothymidine or AZT) was developed. Subsequently more antiviral drugs were developed, and in 1994 the concept of combination antiretroviral therapy emerged.
In 1995, with the discovery of new HIV protease inhibitors, highly active antiretroviral therapy (HAART) was initiated. Improved diagnostics using the HIV-RNA (viral load) were developed in 1997, and in 1999 HIV genotyping and phenotyping were employed to identify drug-resistant strains of HIV. Consequently, short- and long-term complications related to HIV medications, such as fat metabolism disorders and organ dysfunction, were identified as important clinical problems.
To date, the major focus for prevention and control of the HIV/AIDS pandemic has been on the development of an effective vaccine. Although there are many candidates available, no effective vaccine has yet been found.
Epidemiology
In the United States from 1981 to 2001 there were 816,000 cases of AIDS, of which 468,000 (or 58 percent) have resulted in death. Since the mid-1990s, there has been a dramatic decrease in the number of cases and deaths due to HIV, due in large part to the effect of highly active antiretroviral therapy and effective prophylaxis for AIDS-related opportunistic infections. In the United States in 2003, there were an increased number of cumulative cases of HIV/AIDS, but dramatic decreases in cases among some populations such as homosexual men and injection drug users.
Due to effective HIV prophylaxis with antiretroviral drugs given to pregnant women, transmission of HIV from pregnant mothers to their children and cases of pediatric HIV disease have dropped dramatically in the United States. In addition, the use of HAART has markedly decreased mortality, morbidity and opportunistic infections related to HIV infection in all patients.
The global impact of the HIV/AIDS pandemic is incredible. In 2003, more than 42 million cases of HIV/AIDS were identified worldwide, of which more than half have resulted in fatalities. In 2002 alone, more than 5 million new HIV infections were identified, and more than 3 million people died. Sub-Saharan Africa has the highest prevalence of HIV, and in some areas upwards of 25 percent of the population is HIV-infected. This problem is complicated by the lack of adequate resources to effectively combat the epidemic.
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