HIV and AIDS

HIV was first identified in 1983 and has since claimed approximately 40.4 million lives worldwide as of 2022. This number is staggering, and if left unchecked, HIV could become a global health crisis. However, the research, development, and widespread availability of highly active antiretroviral therapies (ARTs) have helped control the HIV pandemic. Likewise, advances in the treatment of HIV and opportunistic infections have rendered the disease a manageable chronic illness. Patients with HIV can live long and healthy lives. Preventing chronic diseases is a top health priority for this population due to the underlying immunodeficiency.

Adequate resources and advances in prevention, treatment, and implementation science make the United Nations General Assembly's 95-95-95 goals attainable. By 2025, the goal is to ensure that 95% of patients with HIV are diagnosed, 95% of diagnosed patients receive ART, and 95% of those prescribed ART achieve viral load suppression.[WHO. Global Health Sector HIV Strategies 2022] Globally, HIV and mortality rates show a steady decrease. However, some countries report an uptrend in the rate of infections, mostly where political or other turmoil is occurring or where HIV is highly stigmatized.[UNAIDS. Global Report 2023] With improvements in treatment, the number of patients with HIV is also increasing, with approximately 37.7 million patients diagnosed in 2020 and 39 million patients diagnosed in 2022—two-thirds of whom live in Africa.

HIV imposes high costs on both patients and the healthcare system. Infection with HIV increases the risk of chronic disease, particularly cardiac and neurological. Although ART delays disease progress, treatment does not cure HIV, causes adverse effects, and requires consistent, prolonged connection to the healthcare system. Several barriers to universal treatment exist, including public- and self-stigma, lack of adequate access to care, inappropriate care, and costs. Using local clinical guidelines for managing HIV improves patient outcomes and prevents HIV transmission. Clinical guidelines promote quality programming for prompt diagnosis, treatment, and connection to care for patients with or at risk of acquiring HIV. Increasing the involvement of community-led organizations in HIV testing and treatment and integrating medical services for related health issues extend the reach of precise services, improve linkage to care, and improve overall health. Supportive social and policy environments regarding access to services, screening, reporting test results, and discrimination can safeguard patients and the community.

This clinical reference focuses primarily on HIV-1 and is designed to review the pathophysiology, clinical manifestations, and recommended treatment options for patients with HIV, providing clinicians with concise and up-to-date guidance for managing HIV. The optimal social and policy environments to support the HIV response, as recommended by the World Health Organization (WHO), the Joint United Nations Programme for HIV/AIDS (UNAIDS), the United States Centers for Disease Control (CDC), and state legislatures, with Florida legislation provided as an example, are discussed. Please see StatPearls' companion resource, "HIV-2 Infection," for more information.[1]