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Graz A. Luzzi

, T.E.A. Peto

, P. Goulder

, and C. P. Conlon



Epidemiology—updated HIV prevalence data and world distribution figure.

Diagnosis—new recommendations on HIV testing in higher prevalence areas.

Primary HIV infection—use of fourth-generation HIV tests; summary of results of the SPARTAC trial on antiretroviral treatment (ART) in primary HIV infection.

HIV and TB—new information on timing of initiation of ART in patients presenting with HIV-associated tuberculosis.

Primary cerebral lymphoma—updated section on treatment and prognosis.

Non-AIDS-defining cancers—new detailed section replaces former section on other tumours in AIDS.

HIV-associated nephropathy—detailed updating.

HIV/HCV coinfection—comment on new HCV protease inhibitors.

Management of HIV infection and prognosis—inclusion of new data on long-term prognosis; management of HIV-negative sexual partners.

Antiretroviral therapy—inclusion of new drugs;–updated recommendations on when to start ART and reference to the START study.

Bone metabolism—comment on osteoporosis, bone fracture risk, and contributing factors.

Prophylaxis of major opportunistic infections in HIV—table updated.

Prevention of HIV transmission—new discussion on risk of sexual transmission in patients on ART; updated information on vaginal microbicides and pre-exposure prophylaxis.

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date: 27 October 2021

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 60 million people and caused more than 30 million deaths. The highest prevalence rates are in sub-Saharan Africa and other parts of the developing world. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid thirties, although HIV incidence has recently declined in some of these high-prevalence countries. However, there are large-scale epidemics of HIV elsewhere, e.g. India, the Russian Federation, and eastern Europe....

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