Key Points

• Of the 33 million persons living with HIV infection worldwide, 1 million live in the United States.

• Incidence of HIV infection in the United States has increased by 15%, whereas mortality has declined by 17% (2004-2007).

• Minorities and women are disproportionately affected by HIV infection.

About 33 million people worldwide are living with HIV/ AIDS in 2007. Of these, 2.7 million have been newly infected, and 2 million people have died of HIV/AIDS. Developing

Box 17-1 Key Events in HIV/AIDS Crisis and Development of Therapy

1959 African man dies of a mysterious viral illness, now recognized as the ancestor of HIV. 1981 CDC reports "gay-related immune deficiency" (GRID) as the cause of outbreaks of deaths of gay men in California and New York.

Cases soon appear among heterosexuals, intravenous drug users, and recipients of blood transfusions 1983 Montagnier and Gallo isolate retrovirus later named HIV.

CDC warns about possible problems with the blood supply. 1985 HIV test is patented by Gallo's laboratory.

Rock Hudson dies; Ryan White refused admission to school. 1987 Advent of zidovudine (AZT or ZDV) as first treatment for HIV infection.

1992 Combination therapy with zalcitabine (ddC) approved.

1993 Definition of AIDS revised by CDC.

Concorde trials from Britain show that patients develop AIDS despite treatment with ZDV.

1996 Advent of protease inhibitors and "triple therapy" regimens. Viral reservoirs persist while viral loads remain undetectable.

1997 ACTG 076 shows AZT in pregnancy and during delivery reduces vertical transmission from 25% to 3%.

CDC reports drop in annual AIDS deaths.

1998 First human trials of a vaccine begin.

Generic HIV medications become available in Europe. 2001 First-entry inhibitor, enfuvirtide (Fuzeon), is developed.

2004 First generic antiretroviral approved by FDA. Combination drugs Truvada (emtricitabine and tenofovir) and Epzicom (abacavir and lamivudine) and new protease inhibitors Reyataz and Lexiva become available.

2005 As side effects of chronic HAART identified, experts recommend delay of HAART initiation.

2006 Current scientific opinion holds origin of HIV in the meat and bites of African monkeys.

2009 HIV genome is decoded.

countries account for more than 95% of these infections (UN AIDS, 2007). Since 1981, an estimated 1.7 million people have been infected; more than 1 million people in the United States are currently living with HIV/AIDS; and 565,927 have died of AIDS. The number of deaths has declined by 17% between 2003 and 2007. From 2004 to 2007, there has been an increase of 15% in the incidence of HIV/AIDS cases in the United States. This increase occurred mainly in persons age 40 to 44, who accounted for 15% of all HIV/AIDS cases, likely caused by both changes in reporting systems and increased HIV testing.

A disproportionate number of minorities and women are affected by HIV. Although the U.S. population is 13% black, blacks constituted 45% of newly diagnosed cases in 2006, with a rate of infection of 83.7 per 100,000. Of these, 60% are women. Blacks living with HIV/AIDS constitute about 60% of the adult HIV-positive population in 2007, with a rate of 76.7 per 100,000. Similarly, Hispanics, although constituting 12% of the population, reflect 17% of those persons newly infected with HIV in 2006 and 20% of those living with HIV/AIDS in 2007, with rates of 29.3 and 20 per 100,000, respectively. Year-end prevalence rates in 2007 were 185.1 per 100,000 population, with a range between 2.2 in Samoa and 1750 per 100,000 in the District of Columbia.

Acquired immunodeficiency syndrome was diagnosed within 12 months of diagnosis of HIV infection for a larger percentage of Hispanics and male intravenous drug users (IVDUs) and men with high-risk heterosexual contact. Survival after AIDS diagnosis has increased in those who were diagnosed between 1998 and 2000, among men who have sex with men (MSM), and those who have acquired HIV perinatally. More whites survive 48 months after a diagnosis of AIDS than minorities. Survival has declined in IVDUs and with each year of age at diagnosis after age 35 (HIV/AIDS Surveillance Report, 2007).

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