In this Article

• When was HIV discovered, and how is it diagnosed?
• How is HIV spread (transmitted)?
• What happens after an exposure to the blood or genital secretions of an HIV-infected person? What are symptoms of primary HIV infection?
• What laboratory tests are used to monitor HIV-infected people?
• What are the key principles in managing HIV infection?
• Should patients with the "flu"- or "mono"-like illness of primary HIV infection be treated?
• What about treatment for HIV during pregnancy?
• What about treating non-HIV-infected people who are exposed to the blood or genital secretions of an HIV-infected person?
• What can be done for people who have severe immunosuppression?
• What is in the future for HIV-infected individuals and for those at risk to contract HIV?
• HIV At A Glance
• Human Immunodeficiency Virus (HIV, AIDS) Glossary
• Human Immunodeficiency Virus (HIV, AIDS) Index

What is in the future for HIV-infected individuals and for those at risk to contract HIV?

Trends continue toward simplifying drug regimens to improve adherence and decrease side effects. In addition, the availability of multiple new drugs in new classes have made it possible to suppress viral load to undetectable levels even in the most treatment-experienced patients. With such great success in treatment, it has been disappointing that there has been much less progress in research related to prevention and establishing a cure. Research is attempting to find ways to enhance the body's natural defenses against HIV in order to control viral growth on and off therapy. Similarly, innovative studies are under way to purge or eliminate the HIV from the body. Although all of this research is exciting, it has been met with little success and for at least the near future, patients will need to remain on antiviral therapy.

The good news is that the development of antiviral therapy has led to marked declines in AIDS-related deaths in many parts of the world. The majority of infected individuals, however, do not have access to the expensive antiviral medications. Accordingly, the best hope for limiting the current epidemic of HIV around the world remains an effective vaccine. Unfortunately, despite increasing research in this area, the development of a vaccine continues to lag far behind the progress that has been made in antiviral therapy.

HIV At A Glance

• The human immunodeficiency virus (HIV) is a type of virus called a retrovirus, which infects humans when it comes in contact with tissues such as those that line the vagina, anal area, mouth, or eyes, or through a break in the skin.
• HIV infection is generally a slowly progressive disease in which the virus is present throughout the body at all stages of the disease.
• Three stages of HIV infection have been described.
  1. The initial stage of infection (primary infection), which occurs within weeks of acquiring the virus, and often is characterized by a "flu-" or "mono-"like illness that generally resolves within weeks.
  2. The stage of chronic asymptomatic infection (meaning a long duration of infection without symptoms) lasts an average of eight to 10 years.
  3. The stage of symptomatic infection, in which the body's immune (or defense) system has been suppressed and complications have developed, is called the acquired immunodeficiency syndrome (AIDS). The symptoms are caused by the complications of AIDS, which include one or more unusual infections or cancers, severe loss of weight, and intellectual deterioration (called dementia).
• When HIV grows (that is, by reproducing itself), it acquires the ability to change (mutate) its own structure. This mutation enables the virus to become resistant to previously effective drug therapy.
• The goals of drug therapy are to prevent damage to the immune system by the HIV virus and to halt or delay the progress of the infection to symptomatic disease.
• Therapy for HIV includes combinations of drugs that decrease the growth of the virus to such an extent that the treatment prevents or markedly delays the development of viral resistance to the drugs.
• The best combination of drugs for HIV has not yet been defined, but one of the most important factors is that the combination be well tolerated so that it can be followed consistently without missing doses.

Previous contributing medical editor: Leslie J. Schoenfield, MD, PhD

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