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CRC - Outpatient Management of HIV Infection

Organization: CRC
Publication Date: 22 June 2011
Page Count: 290


Remarkable advances have been made in the global battle against the acquired immune deficiency syndrome (AIDS). A proliferation of drugs in a variety of classes, some with novel mechanisms of action against the human immunodeficiency virus (HIV), the causative agent of AIDS, has brought a new era to the treatment of this massive global pandemic. A greater understanding of the pathogenesis of the disease, the genetics of resistance to antiretroviral agents, and the optimal timing of treatment has broadened the impact of therapy. For individuals living with HIV/AIDS who have ready access to modern therapy, the disease has been transformed into a chronic, typically manageable condition in which the immune dysfunction can be substantially reversed for decades.

Sadly, though, the advances in therapy and the reduction in death and suffering from HIV/AIDS have been largely confined to the developed world. As has been the case since the epidemic was first identified over 30 years ago, the regions most impacted, including many of the most impoverished countries of the world, have seen only modest progress in clinical outcomes. Despite inspired international efforts to broaden the impact of therapy, some of which are detailed in the final chapter of this book, consistent access to effective therapy remains the exception rather than the rule in most of the countries of sub-Saharan Africa in particular. Discouraging trends have also been seen in regions of the world previously only impacted to a limited degree by HIV/AIDS. The countries of Eastern Europe, including Russia, as well as South Asia and China have seen rising numbers of those infected and have struggled to create and maintain effective services. Parallel epidemics of tuberculosis and viral hepatitis have further complicated care in the same areas of the globe where HIV/AIDS has posed the greatest challenges to health care systems.

Even in environments where effective therapy for HIV itself is widely available, the news is not all favorable. Previously unrecognized and poorly understood complications of HIV infection involving a variety of organ systems have unmasked what may be a phenomenon of premature aging even among those who achieve immune reconstitution and sustained suppression of circulating levels of virus. In addition, new cases of HIV infection continue to occur in large numbers despite decades of education regarding risk behavior even in the wealthiest countries. The development of an effective vaccine, long seen as the ultimate answer to containment of the epidemic across all societies, remains frustratingly elusive.

As other calamities, both natural and man made, medical and political, have impacted the world's population since the dawn of the HIV/AIDS epidemic, the misery caused by this epic disease does not always receive the public attention that it once did. War, famine, climate change, financial instability, environmental disasters, terrorism, and other emerging or reemerging diseases such as pandemic influenza dominate the headlines as HIV/AIDS appears, at times, to have become an accepted addition to the long list of dilemmas faced by the human race.

Through the long and tragic history of this epidemic marked by both striking scientific advances and unimaginable suffering, dedicated workers in laboratories, hospitals, villages, rural clinics, harm reduction centers, governmental offices, academic institutions, and pharmaceutical company boardrooms have carried on the fight undeterred. The intention of this book is to provide a selective update of the global status of HIV/AIDS, highlighting old and new areas of discovery and challenge. Examples of strategies from around the world to contain, prevent, and treat HIV infection and its complications are offered. Some insights gained by the author in working in diverse systems of care are provided. It is hoped that this glimpse into the current state of the struggle against HIV/AIDS will offer a challenge to those wishing to begin or expand their involvement in this struggle-a struggle in which we can and must ultimately prevail.