HIV/AIDS is a global pandemic. The human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS). HIV is a retrovirus, with HIV-1 being the most common throughout the world. HIV-2 was originally identified in West Africa, but cases have now been identified throughout other parts of the world.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 36.9 million individuals across the world were living with HIV in 2017, but only 21.7 million were accessing the needed antiretroviral therapy. Approximately 1.8 million individuals became newly infected with HIV in 2017. Approximately 35.4 million have died since the start of the epidemic in 1990.
In the United States alone 38,739 individuals were newly diagnosed with HIV in 2017. According to the Centers for Disease Control, the annual number of diagnoses remained stable in the US from 2012-2016 with some groups seeing an overall increase. According to the fact sheet provided by the CDC, the groups demonstrating an increase in rates of HIV diagnoses were predominately those with male-to-male sexual contact.
The rates in AIDS-related deaths has declined by about 50% since 2004. Tuberculosis remains the most common cause of death in patients with AIDS. According to UNAIDS, 940,000 individuals died from AIDS-related illnesses world-wide in 2017, as compared with 1.9 million in 2004. This decrease in deaths is likely multifactorial, due to both improvements in antiretroviral therapy, screening, and prophylaxis against opportunistic infections.
Despite the many advances in HIV screening and treatment about 25% of individuals living with HIV are unaware of their diagnosis, according to UNAIDS. As of 2017, about 20% of patients that were aware of their diagnosis were not accessing treatment. Out of those that were accessing treatment, an additional 20% were not virally suppressed. This means that nearly half (47%) of patients with HIV were not virally suppressed as of 2017. Strict adherence to treatment and follow-up is of utmost importance as these are the factors most likely to influence prognosis and survival.
The CDC guidelines recommend screening everyone ages 13-64 years of age and individuals with other high-risk behaviors such as injection drug use, males that have sex with males, those with multiple sexual partners, those with a history of receiving a blood transfusion between 1978-1985, those with a history of sexually transmitted diseases, or any individual requesting an HIV test.
Centers for Disease Control - HIV in the United States and Dependent Areas
CURRENT Practice Guidelines in Primary Care 2019: Chapter 7: Infectious Diseases
Harrison's Principles of Internal Medicine, 20e: Chapter 197: Human Immunodeficiency Virus Disease: AIDS and Related Disorders