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HIV is transmitted primarily via unprotected sexual intercourse (including anal and oral sex),

contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy,
delivery, or breastfeeding.
[2
!ome bodily fluids, such as saliva and tears, do not transmit HIV.
["
#revention of HIV infection, primarily through safe sex andneedle$exchange programs, is a %ey
strategy to control the spread of the disease. &here is no cure or vaccine' ho(ever, antiretroviral
treatment can slo( the course of the disease and may lead to a near$normal life expectancy. )hile
antiretroviral treatment reduces the ris% of death and complications from the disease, these
medications are expensive and have side effects. )ithout treatment, the average survival time after
infection (ith HIV is estimated to be * to ++ years, depending on the HIV subtype.
[,
-enetic research indicates that HIV originated in (est$central .frica during the late nineteenth or
early t(entieth century.
[/
.I0! (as first recogni1ed by the 2nited !tates 3enters for 0isease 3ontrol
and #revention (303) in +*4+ and its cause5HIV infection5(as identified in the early part of the
decade.
[6
!ince its discovery, .I0! has caused an estimated "6 million deaths (orld(ide (as of
27+2).
[8
.s of 27+2, approximately "/." million people are living (ith HIV globally.
[8
HIV9.I0! is
considered a pandemic5a disease outbrea% (hich is present over a large area and is actively
spreading.
[4
HIV9.I0! has had a great impact on society, both as an illness and as a source of discrimination.
&he disease also has significant economic impacts. &here are manymisconceptions about
HIV9.I0! such as the belief that it can be transmitted by casual non$sexual contact. &he disease
has also become sub:ect to manycontroversies involving religion. It has attracted international
medical and political attention as (ell as large$scale funding since it (as identified in the +*47s
Acute infection
;ain symptoms of acute HIV infection
&he initial period follo(ing the contraction of HIV is called acute HIV, primary HIV or acute retroviral
syndrome. ;any individuals develop an influen1a$li%e illness or a mononucleosis$li%e illness 2<,
(ee%s post exposure (hile others have no significant symptoms.
[+"[+,
!ymptoms occur in ,7<*7= of
cases and most commonly include fever,large tender lymph nodes, throat inflammation, a rash,
headache, and9or sores of the mouth and genitals. &he rash, (hich occurs in 27</7= of cases,
presents itself on the trun% and is maculopapular, classically.!ome people also
develop opportunistic infections at this stage. -astrointestinal symptoms such as nausea, vomiting
ordiarrhea may occur, as may neurological symptoms of peripheral neuropathy or -uillain$>arre
syndrome.

&he duration of the symptoms varies, but is usually one or t(o (ee%s
0ue to their nonspecific character, these symptoms are not often recogni1ed as signs of HIV
infection. ?ven cases that do get seen by a family doctor or a hospital are often misdiagnosed as
one of the many common infectious diseases (ith overlapping symptoms. &hus, it is recommended
that HIV be considered in people presenting an unexplained fever (ho may have ris% factors for the
infection
Acquired immunodeficiency syndrome
;ain symptoms of .I0!.
.c@uired immunodeficiency syndrome (.I0!) is defined in terms of either a 30,
A
& cell count belo(
277 cells per BC or the occurrence of specific diseases in association (ith an HIV infection. In the
absence of specific treatment, around half of people infected (ith HIV develop .I0! (ithin ten
years.
[
&he most common initial conditions that alert to the presence of .I0! are pneumocystis
pneumonia (,7=), cachexia in the form of HIV (asting syndrome (27=) and esophageal
candidiasis. Dther common signs include recurring respiratory tract infections.
[

Dpportunistic infections may be caused by bacteria, viruses, fungi and parasites that are normally
controlled by the immune system.
[
)hich infections occur partly depends on (hat organisms are
common in the personEs environment. &hese infections may affect nearly every organ system.
#eople (ith .I0! have an increased ris% of developing various viral induced cancers
including FaposiEs sarcoma,>ur%ittEs lymphoma, primary central nervous system lymphoma,
and cervical cancer. FaposiEs sarcoma is the most common cancer occurring in +7 to 27= of people
(ith HIV. &he second most common cancer is lymphoma (hich is the cause of death of nearly +6=
of people (ith .I0! and is the initial sign of .I0! in " to ,=.>oth these cancers are associated
(ith human herpesvirus 4.
[
3ervical cancer occurs more fre@uently in those (ith .I0! due to its
association (ith human papillomavirus (H#V)
.dditionally, people (ith .I0! fre@uently have systemic symptoms such as prolonged
fevers, s(eats (particularly at night), s(ollen lymph nodes, chills, (ea%ness, and (eight loss.
0iarrhea is another common symptom present in about *7= of people (ith .I0!. &hey can also be
affected by diverse psychiatric and neurological symptoms independent of opportunistic infections
and cancers.
Transmission
HIV is transmitted by three main routesG sexual contact, exposure to infected body fluids or tissues,
and from mother to child during pregnancy, delivery, or breastfeeding (%no(n as vertical
transmission). &here is no ris% of ac@uiring HIV if exposed to feces, nasal secretions, saliva, sputum,
s(eat, tears, urine, or vomit unless these are contaminated (ith blood. It is possible to be co$
infected by more than one strain of HIV5a condition %no(n as HIV superinfection.
Sexual
&he most fre@uent mode of transmission of HIV is through sexual contact (ith an infected
person. &he ma:ority of all transmissions (orld(ide occur through heterosexual contacts (i.e. sexual
contacts bet(een people of the opposite sex)' ho(ever, the pattern of transmission varies
significantly among countries. In the 2nited !tates, as of 277*, most sexual transmission occurred
in men (ho had sex (ith men (ith this population accounting for 6,= of all ne( cases.
.s regards unprotected heterosexual contacts, estimates of the ris% of HIV transmission per sexual
act appear to be four to ten times higher in lo($income countries than in high$income countries. In
lo($income countries, the ris% of female$to$male transmission is estimated as 7."4= per act, and of
male$to$female transmission as 7."7= per act' the e@uivalent estimates for high$income countries
are 7.7,= per act for female$to$male transmission, and 7.74= per act for male$to$female
transmission. &he ris% of transmission from anal intercourse is especially high, estimated as +.,<
+.8= per act in both heterosexual and homosexual contacts. )hile the ris% of transmission from oral
sex is relatively lo(, it is still present. &he ris% from receiving oral sex has been described as Hnearly
nilHho(ever a fe( cases have been reported. &he per$act ris% is estimated at 7<7.7,= for receptive
oral intercourse. In settings involving prostitution in lo( income countries, ris% of female$to$male
transmission has been estimated as 2.,= per act and male$to$female transmission as 7.7/= per
act.
Iis% of transmission increases in the presence of many sexually transmitted infections and genital
ulcers. -enital ulcers appear to increase the ris% approximately fivefold. Dther sexually transmitted
infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated
(ith some(hat smaller increases in ris% of transmission.
&he viral load of an infected person is an important ris% factor in both sexual and mother$to$child
transmission. 0uring the first 2./ months of an HIV infection a personEs infectiousness is t(elve
times higher due to this high viral loadI of the person is in the late stages of infection, rates of
transmission are approximately eightfold greater.
[

3ommercial sex (or%ers (including those in pornography) have an increased rate of HIV. Iough
sex can be a factor associated (ith an increased ris% of transmission. !exual assault is also
believed to carry an increased ris% of HIV transmission as condoms are rarely (orn, physical trauma
to the vagina or rectum is li%ely, and there may be a greater ris% of concurrent sexually transmitted
infections.
Body fluids
303 poster from +*4* highlighting the threat of .I0! associated (ith drug use
&he second most fre@uent mode of HIV transmission is via blood and blood products.
[2
>lood$borne
transmission can be through needle$sharing during intravenous drug use, needle stic% in:ury,
transfusion of contaminated blood or blood product, or medical in:ections (ith unsterilised
e@uipment. &he ris% from sharing a needle during drug in:ection is bet(een 7.6" and 2.,= per act,
(ith an average of 7.4=. &he ris% of ac@uiring HIV from a needle stic% from an HIV$infected person
is estimated as 7."= (about + in """) per act and the ris% follo(ing mucus membrane exposure to
infected blood as 7.7*= (about + in +777) per act. In the 2nited !tates intravenous drug users made
up +2= of all ne( cases of HIV in 277*,

and in some areas more than 47= of people (ho in:ect


drugs are HIV positive.
HIV is transmitted in about *"= of blood transfusions involving infected blood. In developed
countries the ris% of ac@uiring HIV from a blood transfusion is extremely lo( (less than one in half a
million) (here improved donor selection and HIV screening is performed' for example, in the 2F the
ris% is reported at one in five million. In lo( income countries, only half of transfusions may be
appropriately screened (as of 2774), and it is estimated that up to +/= of HIV infections in these
areas come from transfusion of infected blood and blood products, representing bet(een /= and
+7= of global infections.
2nsafe medical in:ections play a significant role in HIV spread in sub$!aharan .frica. In 2778,
bet(een +2 and +8= of infections in this region (ere attributed to medical syringe use. &he )orld
Health Drganisation estimates the ris% of transmission as a result of a medical in:ection in .frica at
+.2=. !ignificant ris%s are also associated (ith invasive procedures, assisted delivery, and dental
care in this area of the (orld.
#eople giving or receiving tattoos, piercings, and scarification are theoretically at ris% of infection but
no confirmed cases have been documented. It is not possible for mos@uitoes or other insects to
transmit HIV.
Mother-to-child
HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast
mil%. &his is the third most common (ay in (hich HIV is transmitted globally. In the absence of
treatment, the ris% of transmission before or during birth is around 27= and in those (ho also
breastfeed "/=..s of 2774, vertical transmission accounted for about *7= of cases of HIV in
children. )ith appropriate treatment the ris% of mother$to$child infection can be reduced to about
+=. #reventive treatment involves the mother ta%ing antiretroviral during pregnancy and delivery, an
elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the
ne(born. ;any of these measures are ho(ever not available in the developing (orld. If blood
contaminates food during pre$che(ing it may pose a ris% of transmission.
HIV testing
;ost people infected (ith HIV develop specific antibodies (i.e. seroconvert) (ithin three to t(elve
(ee%s of the initial infection. 0iagnosis of primary HIV before seroconversion is done by measuring
HIV$IJ. or p2, antigen. #ositive results obtained by antibody or #3I testing are confirmed either
by a different antibody or by #3I.
.ntibody tests in children younger than +4 months are typically inaccurate due to the continued
presence ofmaternal antibodies &hus HIV infection can only be diagnosed by #3I testing for HIV
IJ. or 0J., or via testing for the p2, antigen. ;uch of the (orld lac%s access to reliable #3I
testing and many places simply (ait until either symptoms develop or the child is old enough for
accurate antibody testing. In sub$!aharan .frica as of 2778<277* bet(een "7 and 87= of the
population (as a(are of their HIV status. In 277*, bet(een ".6 and ,2= of men and (omen in !ub$
!aharan countries (ere tested (hich represented a significant increase compared to previous years.
Classifications of HIV infection
&(o main clinical staging systems are used to classify HIV and HIV$related disease
for surveillance purposesG the )HD disease staging system for HIV infection and disease,
[+2
and
the 303 classification system for HIV infection.
[47
&he 303Es classification system is more
fre@uently adopted in developed countries. !ince the)HDEs staging system does not re@uire
laboratory tests, it is suited to the resource$restricted conditions encountered in developing
countries, (here it can also be used to help guide clinical management. 0espite their differences,
the t(o systems allo( comparison for statistical purposes.
[+7[+2[47
&he )orld Health Drgani1ation first proposed a definition for .I0! in +*46.
[+2
!ince then, the )HD
classification has been updated and expanded several times, (ith the most recent version being
published in 2778.
[+2
&he )HD system uses the follo(ing categoriesG
#rimary HIV infectionG ;ay be either asymptomatic or associated (ith acute retroviral
syndrome.
[+2
!tage IG HIV infection is asymptomatic (ith a 30,
A
& cell count (also %no(n as 30, count)
greater than /77 per microlitre (Bl or cubic mm) of blood.
[+2
;ay include generali1ed lymph node
enlargement.
[+2
!tage IIG ;ild symptoms (hich may include minor mucocutaneous manifestations and
recurrent upper respiratory tract infections. . 30, count of less than /779Bl.
[+2
!tage IIIG .dvanced symptoms (hich may include unexplained chronic diarrhea for longer
than a month, severe bacterial infections including tuberculosis of the lung, and a 30, count of
less than "/79Bl.
[+2
!tage IV or .I0!G severe symptoms (hich include toxoplasmosis of the brain, candidiasis of
the esophagus, trachea, bronchi or lungs and FaposiEs sarcoma. . 30, count of less than
2779Bl.
[+2
&he 2nited !tates 3enter for 0isease 3ontrol and #revention also created a classification system for
HIV, and updated it in 2774.
[47
&his system classifies HIV infections based on 30, count and clinical
symptoms,
[47
and describes the infection in three stagesG
!tage +G 30, count K /77 cells9Bl and no .I0! defining conditions
!tage 2G 30, count 277 to /77 cells9Bl and no .I0! defining conditions
!tage "G 30, count L 277 cells9Bl or .I0! defining conditions
2n%no(nG if insufficient information is available to ma%e any of the above classifications
Mor surveillance purposes, the .I0! diagnosis still stands even if, after treatment, the 30,
A
& cell
count rises to above 277 per BC of blood or other .I0!$defining illnesses are cured.
[+7
Prevention
Main article: Prevention of HIV/AIDS
.I0! 3linic, ;cCeod -an:, Himachal #radesh, India, 27+7
Sexual contact
3onsistent condom use reduces the ris% of HIV transmission by approximately 47= over the long
term.
[4+
)hen condoms are used consistently by a couple in (hich one person is infected, the rate of
HIV infection is less than += per year.
[42
&here is some evidence to suggest that female
condoms may provide an e@uivalent level of protection.
[4"
.pplication of a vaginal gel
containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce
infection rates by approximately ,7= among .frican (omen.
[4,
>y contrast, use of
the spermicide nonoxynol$* may increase the ris% of transmission due to its tendency to cause
vaginal and rectal irritation.
[4/
3ircumcision in !ub$!aharan .frica Hreduces the ac@uisition of HIV by
heterosexual men by bet(een "4= and 66= over 2, monthsH.
[46
>ased on these studies, the )orld
Health Drgani1ation and 2J.I0! both recommended male circumcision as a method of preventing
female$to$male HIV transmission in 2778.
[48
)hether it protects against male$to$female transmission
is disputed
[44[4*
and (hether it is of benefit in developed countries and among men (ho have sex
(ith men is undetermined.
[*7[*+[*2
!ome experts fear that a lo(er perception of vulnerability among
circumcised men may cause more sexual ris%$ta%ing behavior, thus negating its preventive effects.
[*"
#rograms encouraging sexual abstinence do not appear to affect subse@uent HIV ris%.
[*,
?vidence
for a benefit from peer education is e@ually poor.
[*/
3omprehensive sexual education provided at
school may decrease high ris% behavior.
[*6
. substantial minority of young people continues to
engage in high$ris% practices despite %no(ing about HIV9.I0!, underestimating their o(n ris% of
becoming infected (ith HIV.
[*8
It is not %no(n (hether treating other sexually transmitted infections
is effective in preventing HIV.
[,2
Pre-exposure
&reating people (ith HIV (hose 30, count K "/7cells9BC (ith antiretrovirals protects *6= of their
partners from infection.
[*4
&his is about a +7 to 27 fold reduction in transmission ris%.
[**
#re$exposure
prophylaxis (#r?#) (ith a daily dose of the medications tenofovir, (ith or (ithout emtricitabine, is
effective in a number of groups including men (ho have sex (ith men, couples (here one is HIV
positive, and young heterosexuals in .frica.
[4,
It may also be effective in intravenous drug users (ith
a study finding a decrease in ris% of 7.8 to 7., per +77 person years.
[+77
2niversal precautions (ithin the health care environment are believed to be effective in decreasing
the ris% of HIV.
[+7+
Intravenous drug use is an important ris% factor and harm reduction strategies
such as needle$exchange programmes and opioid substitution therapy appear effective in
decreasing this ris%.
[+72[+7"
Post-exposure
. course of antiretrovirals administered (ithin ,4 to 82 hours after exposure to HIV$positive blood or
genital secretions is referred to as post$exposure prophylaxis(#?#).
[+7,
&he use of the single
agent 1idovudine reduces the ris% of a HIV infection five$fold follo(ing a needle$stic% in:ury.
[+7,
.s of
27+", the prevention regimen recommended in the 2nited !tates consists of three medications5
tenofovir, emtricitabine and raltegravir5as this may reduce the ris% further.
[+7/
#?# treatment is recommended after a sexual assault (hen the perpetrator is %no(n to be HIV
positive, but is controversial (hen their HIV status is un%no(n.
[+76
&he duration of treatment is usually
four (ee%s
[+78
and is fre@uently associated (ith adverse effects5(here 1idovudine is used, about
87= of cases result in adverse effects such as nausea (2,=), fatigue (22=), emotional distress
(+"=) and headaches (*=).
[2*
Mother-to-child
#rograms to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of
transmission by *2<**=.
[//[+72
&his primarily involves the use of a combination of antiviral
medications during pregnancy and after birth in the infant and potentially includes bottle
feeding rather than breastfeeding.
[//[+74
If replacement feeding is acceptable, feasible, affordable,
sustainable, and safe, mothers should avoid breastfeeding their infants' ho(ever exclusive
breastfeeding is recommended during the first months of life if this is not the case.
[+7*
If exclusive
breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant
decreases the ris% of transmission.
[++7
Vaccination
Main article: HIV vaccine
.s of 27+2 there is no effective vaccine for HIV or .I0!.
[+++
. single trial of the vaccine IV
+,, published in 277* found a partial reduction in the ris% of transmission of roughly "7=,
stimulating some hope in the research community of developing a truly effective vaccine.
[++2
Murther
trials of the IV +,, vaccine are ongoing.
[++"[++,
Management
Main article: Management of HIV/AIDS
&here is currently no cure or effective HIV vaccine. &reatment consists of high active antiretroviral
therapy (H..I&) (hich slo(s progression of the disease
[++/
and as of 27+7 more than 6.6 million
people (ere ta%ing them in lo( and middle income countries.
[++6
&reatment also includes preventive
and active treatment of opportunistic infections.
Antiiral therapy
Abacavir < a nucleoside analog reverse transcriptase inhibitor (J.I&I or JI&I)
3urrent H..I& options are combinations (or Hcoc%tailsH) consisting of at least three medications
belonging to at least t(o types, or Hclasses,H of antiretroviral agents.
[++8
Initially treatment is typically
a non$nucleoside reverse transcriptase inhibitor(JJI&I) plus t(o nucleoside analogue reverse
transcriptase inhibitors (JI&Is).
[++4
&ypical JI&Is includeG 1idovudine (.N&) or tenofovir (&0M)
and lamivudine ("&3) or emtricitabine (M&3).
[++4
3ombinations of agents (hich include a protease
inhibitors (#I) are used if the above regimen loses effectiveness.
[++8
)hen to start antiretroviral therapy is sub:ect to debate.
[+/[++*
&he )orld Health Drgani1ation
recommends antiretrovirals in all adolescents, adults and pregnant (omen (ith a 30, count less
than /779Bl (ith this being especially important in those (ith counts less than "/79Bl or those (ith
symptoms regardless of 30, count.
[++4
&his is supported by the fact that beginning treatment at this
level reduces the ris% of death.
[+27
&he 2nited !tates in addition recommends them for all HIV$
infected people regardless of 30, count or symptoms' ho(ever it ma%es this recommendation (ith
less confidence for those (ith higher counts.
[+2+
)hile the )HD also recommends treatment in
those (ho are co$infected (ith tuberculosis and those (ith chronic active hepatitis >.
[++8
Dnce
treatment is begun it is recommended that it is continued (ithout brea%s or HholidaysH.
[+/
;any
people are diagnosed only after treatment ideally should have begun.
[+/
&he desired outcome of
treatment is a long term plasma HIV$IJ. count belo( /7 copies9mC.
[+/
Cevels to determine if
treatment is effective are initially recommended after four (ee%s and once levels fall belo(
/7 copies9mC chec%s every three to six months are typically ade@uate.
[+/
Inade@uate control is
deemed to be greater than ,77 copies9mC.
[+/
>ased on these criteria treatment is effective in more
than */= of people during the first year.
[+/
>enefits of treatment include a decreased ris% of progression to .I0! and a decreased ris% of death.
[+22
In the developing (orld treatment also improves physical and mental health.
[+2"
)ith treatment
there is a 87= reduced ris% of ac@uiring tuberculosis.
[++8
.dditional benefits include a decreased ris%
of transmission of the disease to sexual partners and a decrease in mother$to$child transmission.
[++8
&he effectiveness of treatment depends to a large part on compliance.
[+/
Ieasons for non$
adherence include poor access to medical care,
[+2,
inade@uate social supports, mental
illness and drug abuse.
[+2/
&he complexity of treatment regimens (due to pill numbers and dosing
fre@uency) and adverse effects may reduce adherence.
[+26
?ven though cost is an important issue
(ith some medications,
[+28
,8= of those (ho needed them (ere ta%ing them in lo( and middle
income countries as of 27+7
[++6
and the rate of adherence is similar in lo($income and high$income
countries.
[+24
!pecific adverse events are related to the antiretroviral agent ta%en.
[+2*
!ome relatively common
adverse events includeG lipodystrophy syndrome, dyslipidemia, anddiabetes mellitus, especially (ith
protease inhibitors.
[+7
Dther common symptoms include diarrhea,
[+2*[+"7
and an increased ris%
of cardiovascular disease.
[+"+
Je(er recommended treatments are associated (ith fe(er adverse
effects.
[+/
3ertain medications may be associated (ith birth defects and therefore may be unsuitable
for (omen hoping to have children.
[+/
&reatment recommendations for children are slightly different from those for adults. In the developing
(orld, as of 27+7, 2"= of children (ho (ere in need of treatment had access.
[+"2
>oth the )orld
Health Drgani1ation and the 2nited !tates recommend treatment for all children less than t(elve
months of age.
[+""[+",
&he 2nited !tates recommends in those bet(een one year and five years of
age treatment in those (ith HIV IJ. counts of greater than +77,777 copies9mC, and in those more
than five years treatments (hen 30, counts are less than /779Bl.
[+""
!pportunistic infections
;easures to prevent opportunistic infections are effective in many people (ith HIV9.I0!. In addition
to improving current disease, treatment (ith antiretrovirals reduces the ris% of developing additional
opportunistic infections.
[+2*
Vaccination against hepatitis . and > is advised for all people at ris% of
HIV before they become infected' ho(ever it may also be given after infection.
[+"/
&rimethoprim9sulfamethoxa1ole prophylaxis bet(een four and six (ee%s of age and ceasing
breastfeeding in infants born to HIV positive mothers is recommended in resource limited settings.
[+"2
It is also recommended to prevent #3# (hen a personEs 30, count is belo( 277 cells9uC and in
those (ho have or have previously had #3#.
[+"6
#eople (ith substantial immunosuppression are
also advised to receive prophylactic therapy for toxoplasmosis and 3ryptococcus meningitis.
[+"8
.ppropriate preventive measures have reduced the rate of these infections by /7= bet(een
+**2 and +**8.
[+"4
Alternatie medicine
In the 2!, approximately 67= of people (ith HIV use various forms of complementary or alternative
medicine,
[+"*
even though the effectiveness of most of these therapies has not been established.
[+,7
)ith respect to dietary advice and .I0! some evidence has sho(n a benefit
from micronutrient supplements.
[+,+
?vidence for supplementation (ith selenium is mixed (ith some
tentative evidence of benefit.
[+,2
&here is some evidence that vitamin . supplementation in children
reduces mortality and improves gro(th.
[+,+
In .frica in nutritionally compromised pregnant and
lactating (omen a multivitamin supplementation has improved outcomes for both mothers and
children.
[+,+
0ietary inta%e of micronutrients at I0. levels by HIV$infected adults is recommended by
the )orld Health Drgani1ation.
[+,"[+,,
&he )HD further states that several studies indicate that
supplementation of vitamin ., 1inc, and iron can produce adverse effects in HIV positive adults.
[+,,
&here is not enough evidence to support the use of herbal medicines.
[+,/
Prognosis
0isability$ad:usted life year for HIV and .I0! per +77,777 inhabitants as of 277,.
no data
10
1025
2550
50100
100500
5001000
10002500
25005000
50007500
7500-10000
10000-50000
50000
HIV9.I0! has become a chronic rather than an acutely fatal disease in many areas of the (orld.
[+,6
#rognosis varies bet(een people, and both the 30, count and viral load are useful for predicted
outcomes.
[+,
)ithout treatment, average survival time after infection (ith HIV is estimated to be * to
++ years, depending on the HIV subtype.
[,
.fter the diagnosis of .I0!, if treatment is not available,
survival ranges bet(een 6 and +* months.
[+,8[+,4
H..I& and appropriate prevention of opportunistic
infections reduces the death rate by 47=, and raises the life expectancy for a ne(ly diagnosed
young adult to 27</7 years.
[+,6[+,*[+/7
&his is bet(een t(o thirds
[+,*
and nearly that of the general
population.
[+/[+/+
If treatment is started late in the infection, prognosis is not as goodG
[+/
for example,
if treatment is begun follo(ing the diagnosis of .I0!, life expectancy is O+7<,7 years.
[+/[+,6
Half of
infants born (ith HIV die before t(o years of age (ithout treatment.
[+"2
&he primary causes of death from HIV9.I0! are opportunistic infections and cancer, both of (hich
are fre@uently the result of the progressive failure of the immune system.
[+"4[+/2
Iis% of cancer
appears to increase once the 30, count is belo( /779PC.
[+/
&he rate of clinical disease progression
varies (idely bet(een individuals and has been sho(n to be affected by a number of factors such as
a personEs susceptibility and immune function'
[+/"
their access to health care, the presence of co$
infections'
[+,8[+/,
and the particular strain (or strains) of the virus involved.
[+//[+/6
&uberculosis co$infection is one of the leading causes of sic%ness and death in those (ith HIV9.I0!
being present in a third of all HIV infected people and causing 2/= of HIV related deaths.
[+/8
HIV is
also one of the most important ris% factors for tuberculosis.
[+/4
Hepatitis 3 is another very common
co$infection (here each disease increases the progression of the other.
[+/*
&he t(o most common
cancers associated (ith HIV9.I0! areFaposiEs sarcoma and .I0!$related non$Hodg%inEs lymphoma.
[+/2
?ven (ith anti$retroviral treatment, over the long term HIV$infected people may
experience neurocognitive disorders,
[+67
osteoporosis,
[+6+
neuropathy,
[+62
cancers,
[+6"[+6,
nephropathy,
[+6/
and cardiovascular disease.
[+"7
It is not clear (hether these conditions result from the HIV
infection itself or are adverse effects of treatment.
Epidemiology
Main article: Epidemiology of HIV/AIDS
?stimated prevalence in = of HIV among young adults (+/<,*) per country as of 27++.
[+66
No data
<0.10
0.100.5
0.51
15
515
1550
HIV9.I0! is a global pandemic.
[+68
.s of 27+2, approximately "/." million people have HIV
(orld(ide (ith the number of ne( infections that year being about 2." million.
[+64
&his is do(n from
".+ million ne( infections in 277+.
[+64
Df these approximately +6.4 million are (omen and "., million
are less than +/ years old.
[++6
It resulted in about +.6 million deaths in 27+2, do(n from a pea% of
2.2 million in 277/.
[++6[+64
!ub$!aharan .frica is the region most affected. In 27+7, an estimated 64= (22.* million) of all HIV
cases and 66= of all deaths (+.2 million) occurred in this region.
[+6*
&his means that about /= of the
adult population is infected
[+87
and it is believed to be the cause of +7= of all deaths in children.
[+8+
Here in contrast to other regions (omen compose nearly 67= of cases.
[+6*
!outh .frica has the
largest population of people (ith HIV of any country in the (orld at /.* million.
[+6*
Cife
expectancy has fallen in the (orst$affected countries due to HIV9.I0!' for example, in 2776 it (as
estimated that it had dropped from 6/ to "/ years in >ots(ana.
[4
;other$to$child transmission, as of
27+", in >ots(ana and !outh .frica has decreased to less than /= (ith improvement in many other
.frican nations due to improved access to antiretroviral therapy.
[+82
!outh Q !outh ?ast .sia is the second most affected' in 27+7 this region contained an estimated
, million cases or +2= of all people living (ith HIV resulting in approximately 2/7,777 deaths.
[+87
.pproximately 2., million of these cases are in India.
[+6*
In 2774 in the 2nited !tates approximately +.2 million people (ere living (ith HIV, resulting in about
+8,/77 deaths. &he 2! 3enters for 0isease 3ontrol and #revention estimated that in 2774 27= of
infected .mericans (ere una(are of their infection.
[+8"
In the 2nited Fingdom as of 277* there
(here approximately 46,/77 cases (hich resulted in /+6 deaths.
[+8,
In 3anada as of 2774 there
(ere about 6/,777 cases causing /" deaths.
[+8/
>et(een the first recognition of .I0! in +*4+ and
277* it has led to nearly "7 million deaths.
[+86
#revalence is lo(est in ;iddle ?ast and Jorth .frica at
7.+= or less, ?ast .sia at 7.+= and )estern and 3entral ?urope at 7.2=.
[+87
&he (orst affected
?uropean countries in 277* are ?stonia, 2%raine, Iussia, Catvia and #ortugal.
[+88
History
Main article: History of HIV/AIDS
"iscoery
&he Morbidity and Mortality Weely !eport reported in +*4+ on (hat (as later to be called H.I0!H.
.I0! (as first clinically observed in +*4+ in the 2nited !tates.
[2"
&he initial cases (ere a cluster of
in:ecting drug users and homosexual men (ith no %no(n cause of impaired immunity (ho sho(ed
symptoms of Pne"mocystis carinii pneumonia (#3#), a rare opportunistic infection that (as %no(n
to occur in people (ith very compromised immune systems.
[+84
!oon thereafter, an unexpected
number of gay men developed a previously rare s%in cancer called FaposiEs sarcoma(F!).
[+8*
[+47
;any more cases of #3# and F! emerged, alerting 2.!. 3enters for 0isease 3ontrol and
#revention (303) and a 303 tas% force (as formed to monitor the outbrea%.
[+4+
In the early days, the 303 did not have an official name for the disease, often referring to it by (ay
of the diseases that (ere associated (ith it, for example, lymphadenopathy, the disease after (hich
the discoverers of HIV originally named the virus.
[+42[+4"
&hey also used #aposi$s Sarcoma and
%pport"nistic Infections, the name by (hich a tas% force had been set up in +*4+.
[+4,
.t one point,
the 303 coined the phrase Hthe ,H diseaseH, since the syndrome seemed to affect Haitians,
homosexuals, hemophiliacs, and heroin users.
[+4/
In the general press, the term H-II0H, (hich stood
for gay$related immune deficiency, had been coined.
[+46
Ho(ever, after determining that .I0! (as
not isolated to the gay community,
[+4,
it (as reali1ed that the term -II0 (as misleading and the
term .I0! (as introduced at a meeting in Ruly +*42.
[+48
>y !eptember +*42 the 303 started
referring to the disease as .I0!.
[+44
In +*4", t(o separate research groups led by Iobert -allo and Cuc ;ontagnier independently
declared that a novel retrovirus may have been infecting people (ith .I0!, and published their
findings in the same issue of the :ournalScience.
[+4*[+*7
-allo claimed that a virus his group had
isolated from a person (ith .I0! (as stri%ingly similar in shape to other human &$lymphotropic
viruses (H&CVs) his group had been the first to isolate. -alloEs group called their ne(ly isolated virus
H&CV$III. .t the same time, ;ontagnierEs group isolated a virus from a person presenting (ith
s(elling of the lymph nodes of the nec% and physical (ea%ness, t(o characteristic symptoms of
.I0!. 3ontradicting the report from -alloEs group, ;ontagnier and his colleagues sho(ed that core
proteins of this virus (ere immunologically different from those of H&CV$I. ;ontagnierEs group
named their isolated virus lymphadenopathy$associated virus (C.V).
[+4+
.s these t(o viruses turned
out to be the same, in +*46, C.V and H&CV$III (ere renamed HIV.
[+*+
!rigins
Ceft to rightG the .frican green mon%ey source of!IV, the sooty mangabey source of HIV$2 and
thechimpan1ee source of HIV$+
>oth HIV$+ and HIV$2 are believed to have originated in non$human primates in )est$central .frica
and (eretransferred to humans in the early 27th century.
[/
HIV$+ appears to have originated in
southern 3ameroonthrough the evolution of !IV(cp1), a simian immunodeficiency virus (!IV) that
infects (ild chimpan1ees (HIV$+ descends from the !IVcp1 endemic in the chimpan1ee
subspecies Pan troglodytes troglodytes).
[+*2[+*"
&he closest relative of HIV$2 is !IV(smm), a virus of
the sooty mangabey (&ercoceb"s atys atys), an Dld )orld mon%ey living in coastal )est .frica
(from southern !enegal to (estern 3Ste dEIvoire).
[66
Je( )orld mon%eyssuch as the o(l
mon%ey are resistant to HIV$+ infection, possibly because of a genomic fusion of t(o viral resistance
genes.
[+*,
HIV$+ is thought to have :umped the species barrier on at least three separate occasions,
giving rise to the three groups of the virus, ;, J, and D.
[+*/
&here is evidence that humans (ho participate in bushmeat activities, either as hunters or as
bushmeat vendors, commonly ac@uire !IV.
[+*6
Ho(ever, !IV is a (ea% virus (hich is typically
suppressed by the human immune system (ithin (ee%s of infection. It is thought that several
transmissions of the virus from individual to individual in @uic% succession are necessary to allo( it
enough time to mutate into HIV.
[+*8
Murthermore, due to its relatively lo( person$to$person
transmission rate, !IV can only spread throughout the population in the presence of one or more
high$ris% transmission channels, (hich are thought to have been absent in .frica before the 27th
century.
!pecific proposed high$ris% transmission channels, allo(ing the virus to adapt to humans and spread
throughout the society, depend on the proposed timing of the animal$to$human crossing. -enetic
studies of the virus suggest that the most recent common ancestor of the HIV$+ ; group dates bac%
to circa +*+7.
[+*4
#roponents of this dating lin% the HIV epidemic (ith the emergence
of colonialism and gro(th of large colonial .frican cities, leading to social changes, including a
higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high
fre@uency of genital ulcer diseases (such as syphilis) in nascent colonial cities.
[+**
)hile
transmission rates of HIV during vaginal intercourse are lo( under regular circumstances, they are
increased many fold if one of the partners suffers from a sexually transmitted infection causing
genital ulcers. ?arly +*77s colonial cities (ere notable due to their high prevalence of prostitution
and genital ulcers, to the degree that, as of +*24, as many as ,/= of female residents of
eastern Finshasa (ere thought to have been prostitutes, and, as of +*"", around +/= of all
residents of the same city had syphilis.
[+**
.n alternative vie( holds that unsafe medical practices in .frica after )orld )ar II, such as unsterile
reuse of single use syringes during mass vaccination, antibiotic and anti$malaria treatment
campaigns, (ere the initial vector that allo(ed the virus to adapt to humans and spread.
[+*8[277[27+
&he earliest (ell documented case of HIV in a human dates bac% to +*/* in the 3ongo.
[272
&he virus
may have been present in the 2nited !tates as early as +*66,
[27"
but the vast ma:ority of infections
occurring outside sub$!aharan .frica (including the 2.!.) can be traced bac% to a single un%no(n
individual (ho became infected (ith HIV in Haiti and then brought the infection to the 2nited !tates
some time around +*6*.
[27,
&he epidemic then rapidly spread among high$ris% groups (initially,
sexually promiscuous men (ho have sex (ith men). >y +*84, the prevalence of HIV$+ among gay
male residents of Je( Tor% and !an Mrancisco (as estimated at /=, suggesting that several
thousand individuals in the country had been infected.
[27,
Society and culture
Stigma
Iyan )hite became aposter child for HIV after being expelled from school because he (as infected.
Main article: Discrimination against people 'it( HIV/AIDS
.I0! stigma exists around the (orld in a variety of (ays, including ostracism, re:ection,
discrimination and avoidance of HIV infected people' compulsory HIV testing (ithout prior consent or
protection of confidentiality' violence against HIV infected individuals or people (ho are perceived to
be infected (ith HIV' and the @uarantine of HIV infected individuals.
[27/
!tigma$related violence or
the fear of violence prevents many people from see%ing HIV testing, returning for their results, or
securing treatment, possibly turning (hat could be a manageable chronic illness into a death
sentence and perpetuating the spread of HIV.
[276
.I0! stigma has been further divided into the follo(ing three categoriesG
Instr"mental AIDS stigma5a reflection of the fear and apprehension that are li%ely to be
associated (ith any deadly and transmissible illness.
[278
Symbolic AIDS stigma5the use of HIV9.I0! to express attitudes to(ard the social groups or
lifestyles perceived to be associated (ith the disease.
[278
&o"rtesy AIDS stigma5stigmati1ation of people connected to the issue of HIV9.I0! or HIV$
positive people.
[274
Dften, .I0! stigma is expressed in con:unction (ith one or more other stigmas, particularly those
associated (ith homosexuality,bisexuality, promiscuity, prostitution, and intravenous drug use.
[27*
In many developed countries, there is an association bet(een .I0! and homosexuality or
bisexuality, and this association is correlated (ith higher levels of sexual pre:udice, such as anti$
homosexual9bisexual attitudes.
[2+7
&here is also a perceived association bet(een .I0! and all male$
male sexual behavior, including sex bet(een uninfected men.
[278
Ho(ever, the dominant mode of
spread (orld(ide for HIV remains heterosexual transmission.
[2++
In 277", as part of an overall reform of marriage and population legislation, it became legal for
people (ith .I0! to marry in 3hina.
[2+2
#conomic impact
Main articles: Economic impact of HIV/AIDS and &ost of HIV treatment
3hanges in life expectancy in some .frican countries
HIV9.I0! affects the economics of both individuals and countries.
[+8+
&he gross domestic product of
the most affected countries has decreased due to the lac% of human capital.
[+8+[2+"
)ithout proper
nutrition, health care and medicine, large numbers of people die from .I0!$related complications.
&hey (ill not only be unable to (or%, but (ill also re@uire significant medical care. It is estimated that
as of 2778 there (ere +2 million .I0! orphans.
[+8+
;any are cared for by elderly grandparents.
[2+,
>y affecting mainly young adults, .I0! reduces the taxable population, in turn reducing the
resources available for public expenditures such as education and health services not related to
.I0! resulting in increasing pressure for the stateEs finances and slo(er gro(th of the economy.
&his causes a slo(er gro(th of the tax base, an effect that is reinforced if there are gro(ing
expenditures on treating the sic%, training (to replace sic% (or%ers), sic% pay and caring for .I0!
orphans. &his is especially true if the sharp increase in adult mortality shifts the responsibility and
blame from the family to the government in caring for these orphans.
[2+,
.t the household level, .I0! causes both loss of income and increased spending on healthcare. .
study in3Ste dEIvoire sho(ed that households having a person (ith HIV9.I0!, spent t(ice as much
on medical expenses as other households. &his additional expenditure also leaves less income to
spend on education and other personal or family investment.
[2+/
$eligion and AI"S
Main article: !eligion and HIV/AIDS
&he topic of religion and .I0! has become highly controversial in the past t(enty years, primarily
because some religious authorities have publicly declared their opposition to the use of condoms.
[2+6
[2+8
&he religious approach to prevent the spread of .I0! according to a report by .merican health
expert ;atthe( Hanley titled )(e &at(olic &("rc( and t(e *lobal AIDS &risis argues that cultural
changes are needed including a re$emphasis on fidelity (ithin marriage and sexual abstinence
outside of it.
[2+8
!ome religious organisations have claimed that prayer can cure HIV9.I0!. In 27++, the >>3
reported that some churches in Condon (ere claiming that prayer (ould cure .I0!, and
the Hac%ney$based 3entre for the !tudy of !exual Health and HIV reported that several people
stopped ta%ing their medication, sometimes on the direct advice of their pastor, leading to a number
of deaths.
[2+4
&he !ynagogue 3hurch Df .ll Jations advertise an Hanointing (aterH to promote -odEs
healing, although the group deny advising people to stop ta%ing medication.
[2+4
Media portrayal
Main article: Media portrayal of HIV/AIDS
Dne of the first high$profile cases of .I0! (as the .merican Ioc% Hudson, a gay actor (ho had
been married and divorced earlier in life, (ho died on 2 Dctober +*4/ having announced that he (as
suffering from the virus on 2/ Ruly that year. He had been diagnosed during +*4,.
[2+*
. notable
>ritish casualty of .I0! that year (as Jicholas ?den, a gay politician and son of the late prime
minister .nthony ?den.
[227
Dn Jovember 2,, +**+, the virus claimed the life of >ritish roc%
starMreddie ;ercury, lead singer of the band Uueen, (ho died from an .I0! related illness having
only revealed the diagnosis on the previous day.
[22+
Ho(ever he had been diagnosed as HIV
positive during +*48.
[222
Dne of the first high$profile heterosexual cases of the virus (as .rthur .she,
the .merican tennis player. He (as diagnosed as HIV positive on "+ .ugust +*44, having
contracted the virus from blood transfusions during heart surgery earlier in the +*47s. Murther tests
(ithin 2, hours of the initial diagnosis revealed that .she had .I0!, but he did not tell the public
about his diagnosis until .pril +**2.
[22"
He died, aged ,*, as a result on 6 Mebruary +**".
[22,
&herese MrareEs photograph of gay activist 0avid Firby, as he lay dying from .I0! (hile surrounded
by family, (as ta%en in .pril +**7. +I,E maga-ine said the photo became the one image Hmost
po(erfully identified (ith the HIV9.I0! epidemic.H &he photo (as displayed in +I,E maga-ine, (as
the (inner of the )orld #ress #hoto, and ac@uired (orld(ide notoriety after being used in a 2nited
3olors of >enetton advertising campaign in +**2.
[22/
In +**6, Rohnson .1iga a 2gandan$born
3anadian (as diagnosed (ith HIV, but subse@uently had unprotected sex (ith ++ (omen (ithout
disclosing his diagnosis. >y 277" seven had contracted HIV, and t(o died from complications
related to .I0!.
[226[228
.1iga (as convicted of first$degree murder and is liable to a life sentence.
[224
"enial% conspiracies
Main articles: AIDS denialism and Discredited HIV/AIDS origins t(eories
. small group of individuals continue to dispute the connection bet(een HIV and .I0!,
[22*
the
existence of HIV itself, or the validity of HIV testing and treatment methods.
[2"7[2"+
&hese claims,
%no(n as .I0! denialism, have been examined and re:ected by the scientific community.
[2"2
Ho(ever, they have had a significant political impact, particularly in !outh .frica, (here the
governmentEs official embrace of .I0! denialism (+***<277/) (as responsible for its ineffective
response to that countryEs .I0! epidemic, and has been blamed for hundreds of thousands of
avoidable deaths and HIV infections.
[2""[2",[2"/
!everal discredited conspiracy theories have held that HIV (as created by scientists, either
inadvertently or deliberately. Dperation IJM?F&IDJ (as a (orld(ide !oviet active
measures operation to spread the claim that the 2nited !tates had created HIV9.I0!. !urveys sho(
that a significant number of people believed < and continue to believe < in such claims.
[2"6
Misconceptions
Main article: Misconceptions abo"t HIV/AIDS
&here are many misconceptions about HIV and .I0!. &hree of the most common are that .I0! can
spread through casual contact, that sexual intercourse (ith a virgin (ill cure .I0!,
[2"8[2"4[2"*
and that
HIV can infect only homosexual men and drug users. Dther misconceptions are that any act of anal
intercourse bet(een t(o uninfected gay men can lead to HIV infection, and that open discussion of
homosexuality and HIV in schools (ill lead to increased rates of homosexuality and .I0!.
[2,7[2,+
Research
Main article: HIV/AIDS researc(
HIV9.I0! research includes all medical research (hich attempts to prevent, treat, or cure HIV9.I0!
along (ith fundamental research about the nature of HIV as an infectious agent and .I0! as the
disease caused by HIV.
;any governments and research institutions participate in HIV9.I0! research. &his research
includes behavioral health interventions such as sex education, anddrug development, such as
research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs.
Dther medical research areas include the topics of pre$exposure prophylaxis, post$exposure
prophylaxis, and circumcision and HIV.