HIV/AIDS: An Update ________________________________________________________________________
partner from an endemic country. Differences in the global spread are attributed to differences in transmissibility and duration of infectiousness [2]. According to the World Health Organization (WHO), an estimated 39.9 million individuals worldwide were living with HIV at the end of 2023, 65% of whom are in the WHO African Region [5]. One study using HIV prevalence data from 68 countries noted that, in 2022, among the 37 million individuals infected with HIV, 53% were located in Southern/ East Africa in one of 14 high-prevalence countries (defined as an HIV-prevalence rate of >3.5%); the remaining 47% of HIV- infections were spread across the globe. This study highlights that in 2022, although the overall rate of new infections were lower, for the first time there were more new HIV infections (770,000 vs. 468,000), more HIV-related deaths (383,000 vs. 225,000), higher rates of mother-to-child transmission (16% vs. 9%), and lower antiretroviral therapy (ART) coverage (67% vs. 83%) in low-prevalence countries versus high-prevalence countries. The annual epidemic growth rate in 2022 was 2.41% for high-prevalence countries, compared with 4.41% for low-prevalence countries; the highest epidemic growth rates (>5.2%) were found in Central and South America, Central Africa, and Central and East Asia [4; 7]. Allocation of funding for treatment and prevention is noted as a potential cause for the shift in epidemic growth rates, as the majority of global efforts are concentrated in Southern and East Africa. Beginning in 2003, the U.S. government has worked to fight HIV/AIDS on a global level, partially through the implemen- tation of the President’s Emergency Plan for AIDS Relief (PEPFAR) [6]. PEPFAR operates in more than 50 countries, including Africa, Asia, and the Western Hemisphere, and provided HIV treatment for more than 20.6 million people in 2024 alone, including 566,000 children. PEPFAR continu- ously operated with bipartisan support in Congress from 2003 through 2025; however, a freeze to U.S. foreign aid in January 2025 left many programs without resources to continue HIV prevention services and treatments. Additionally, systems for the management of clinical data, survey data, and other critical strategic information for planning and program management were interrupted by the funding freeze. Although granted a limited waiver to implement urgent life-saving HIV treatment services, the future of PEPFAR funding and recipients who immediately rely on the services provided are uncertain as of March 2025 [44; 45]. UNITED STATES STATISTICS At year-end 2022, an estimated 1.238 million individuals 13 years of age or older were living with HIV/AIDS in the United States. The CDC estimates that approximately 11% of these individuals were unaware of their infection [9]. In 2022, the Centers for Disease Control and Prevention (CDC) report several statistics and trends in the prevalence of HIV/AIDS in the United States [9]:
INTRODUCTION Despite scientific advances in our understanding of pathogen- esis and transmission and expanded options for prevention and treatment, human immunodeficiency virus (HIV) infection remains a complex, challenging clinical problem and health concern. In the United States, the prevalence of infection has increased substantially among young women and among the elderly in recent decades. The former has serious implica- tions for maternal and child health; the latter presents new challenges for nurses and physicians who provide elder care. The purpose of this course is to provide a basic, practical review and update of knowledge concerning HIV infection and acquired immune deficiency syndrome (AIDS), addressing the key issues that impact clinical and public health practice. Topics to be addressed include immunopathogenesis, modes of transmission, natural history and clinical staging, risk behavior assessment, prevention (including postexposure prophylaxis), diagnosis, management, and follow-up.
EPIDEMIOLOGY
GLOBAL IMPACT The global healthcare community first became aware of the illness now known as HIV/AIDS in 1981. In subsequent decades, the HIV pandemic, and associated disease burden of AIDS, emerged as a major public health issue worldwide. The incidence of HIV infection continues to escalate in some developing countries of the world, compared with a notable stabilization in new cases and fatalities in most developed countries. Two human immunodeficiency viruses, HIV-1 and HIV-2, have been identified and both cause AIDS. Researchers in the United States and England have traced the ancestry of the HIV-1 virus to two strains found in African red-capped mangabeys and greater spot-nosed monkeys. The strains most likely combined in chimpanzees that ate the monkeys, resulting in the chimpanzees developing simian immunodeficiency virus (SIV). Chimpanzees then transmitted the virus to humans, likely around 1908. Genetic studies suggest that the lower monkeys first became infected with SIV 100,000 years ago [1]. HIV-1 is the most common type of HIV, accounting for more than 99.5% of all cases globally [3]. HIV-2 accounts for less than 1% of all cases of HIV and is believed to be endemic in West Africa, though even areas with previously high rates (e.g., Senegal) are seeing HIV-2 being increasingly overtaken by HIV-1 [1]. Several well-documented cases of HIV-2 infection have been reported in Europeans and among West Africans residing abroad, the majority of which were associated with immigration from, travel to, or a sexual
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MDCT2026
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