Global Mortality and Morbidity of HIV/AIDS

Excerpt

The HIV/AIDS epidemic has seen dramatic shifts since the first cases were described in 1981. Initially perceived as a disease among gay men or Haitians in Western countries, HIV transmission has been reported in virtually all parts of the world. Prevalence levels in the 1990s reached more than 30 percent among adults in many Sub-Saharan African cities, and no accessible, effective treatment was available. Although treatment was available for a limited number of people in wealthier settings shortly after the studies on triple therapy in 1996, mortality nevertheless soared, particularly in Sub-Saharan Africa, slashing the hard-won gains in life expectancy resulting from social and economic development and advances in medical technology and nutrition (United Nations Population Division 2004) by more than a decade within a few years.

Since 2000, remarkable progress has been made in the diagnosis and treatment of persons living with HIV/AIDS. With medications now affordable at a cost of approximately US$129–$568 per person per year even in the hardest hit countries (Bendavid and others 2010; Menzies, Berruti, and Blandford 2012; PEPFAR 2013; UNAIDS 2015a; Walensky and others 2013), 17 million people were receiving antiretroviral therapy (ART) in 2015. The international targets are to treat nearly three-quarters of those living with HIV/AIDS by 2030 (UNAIDS 2012, 2014b, 2015b, 2016b; WHO 2013c).

ART has reduced HIV/AIDS morbidity and mortality significantly (Cohen and others 2011; Danel and others 2015; INSIGHT START Study Group 2015; Kitahata and others 2009; Lopez-Cortes, Gutierrez-Valencia, and Ben-Marzouk-Hidalgo 2016; Lundgren, Babiker, and Neaton 2016; Médecins Sans Frontières 2013; Montaner and others 2006; SMART Study Group and others 2006; Sterne and others 2009; Violari and others 2008). In high-income countries (HICs), access to early treatment has led to near-normal life expectancy for persons living with HIV/AIDS (Johnson and others 2013; May and others 2014; Rodger and others 2013; Samji and others 2013). As a result, the focus of clinical care of HIV/AIDS in these settings has shifted from treatment of a usually fatal infectious disease with multiple comorbidities (see chapter 4 [Harripersaud and others 2017] and chapter 11 [Bloom and others 2017] of this volume) to management of a chronic condition and prevention of illness, death, and transmission for individuals who remain adherent to treatment (Attia and others 2009; Cohen and others 2011; Das and others 2010; Fang and others 2004; Montaner and others 2010).