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HIV in the developing world 

HIV in the developing world

HIV in the developing world

Alison D. Grant

and Kevin M. De Cock



Epidemiology—reduction in HIV incidence in some countries.

Transmission—immediate ART for the HIV-infected partner in discordant couples greatly reduces transmission.

Mother-to-child transmission—new advice on breast-feeding.

Tuberculosis—diagnosis, prophylaxis and treatment.

Treatment—increased deployment of ART in developing countries; revised WHO recommendations for ART for pregnant women; IRIS and cryptococcal meningitis.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

The developing world is disproportionately affected by the HIV pandemic. In many countries in sub-Saharan Africa, HIV infection is established in the general population: in southern Africa, which is particularly severely affected, HIV prevalence among pregnant women reached around 40% by 2003 in some areas. Local epidemiology depends on the relative contribution of the three major routes of HIV transmission: sexual contact (heterosexual and homosexual); mother to child; and exposure to blood or blood products. The main route of transmission is sex between men and women.

Clinical features—these vary by geographical region, reflecting increased exposure in developing countries to common pathogens such as tuberculosis, nontyphoid salmonellae, and Streptococcus pneumoniae throughout the course of HIV infection. People with advanced immunosuppression are also at risk of disease due to geographically-restricted opportunistic pathogens, e.g. leishmania and Penicillium marneffei.

Diagnosis and management—diagnosis of HIV-related disease may be difficult where there is limited access to laboratory diagnostics, and presumptive therapy based on the most likely aetiologies is often necessary. Antiretroviral therapy (ART) is increasingly available using clinical eligibility criteria, standardized drug regimens, and simpler monitoring.

Prognosis—the underlying natural history of HIV infection in the developing world is little different from that in industrialized nations, but survival with advanced HIV disease is short if there is no access to ART or interventions to prevent and treat HIV-related infections.

Prevention—this requires political commitment to creating an environment that supports education about HIV, and prevents stigma and discrimination. Some countries have implemented successful control programmes and have seen declining HIV prevalence, but the goal of preventing HIV transmission remains elusive in many settings. Trial results showing high efficacy of ART in preventing transmission between discordant couples has led to renewed optimism; work is ongoing to explore how these results should be translated into policy and practice. Prevention interventions for general populations should include information and education; promotion of partner reduction and of condoms, which are highly protective against sexual transmission if used correctly and consistently; and encouragement of universal knowledge of HIV serostatus. Targeted interventions should be focused on groups and situations in which HIV transmission is most intense, guided by local epidemiology. Male circumcision has a protective efficacy of almost 60% against heterosexual acquisition of HIV infection in men, but other methods of prevention must still be promoted among circumcised men. No vaccine is available.

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