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HIV/AIDS in the Fourth Decade: Origins, Epidemiology, Clinical Manifestations, and Treatment 

HIV/AIDS in the Fourth Decade: Origins, Epidemiology, Clinical Manifestations, and Treatment
Chapter:
HIV/AIDS in the Fourth Decade: Origins, Epidemiology, Clinical Manifestations, and Treatment
Author(s):

Michael J. Mugavero

, and J. Michael Kilby

DOI:
10.1093/med/9780199392742.003.0002
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date: 18 August 2019

This chapter discusses the maturing HIV/AIDS epidemic, now in its fourth decade, with global scale-up of antiretroviral therapy (ART) and reductions in the number of new HIV cases in many regions in the world. Advances in biomedical prevention with promising clinical trial findings for pre-exposure prophylaxis (PrEP) and microbicides provide a scientific foundation for the prevention of new infections in persons who are HIV uninfected and at risk. Landmark trials identifying the benefits of ART treatment as prevention (TasP) of new HIV infections and demonstrating the benefits of early ART initiation at higher CD4 counts have informed global guidelines. The pendulum has swung back to recommending early ART initiation for all persons living with HIV upon learning of a new diagnosis. However, late diagnosis persists as a formidable challenge, and gaps in engagement in medical care among diagnosed persons, as depicted by the treatment cascade, as well as suboptimal adherence to biomedical prevention and ART threaten the effectiveness of these scientific discoveries. The tools and resources are available to hasten the end of HIV/AIDS around the globe with integration of service delivery to address the medical, psychiatric, psychological, and societal impact the virus poses to individuals and communities living with and at risk for HIV/AIDS.

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