Natural history of HIV and AIDS

Medical knowledge of HIV is rapidly evolving, leading to increased understanding of the disease, its immunology and clinical manifestations. Antiretroviral therapy (ART) has provided a means of controlling but not curing the disease, and patients now live longer, healthier lives with the disease. However, new challenges are emerging, including those of treating a population ageing on ART and continuing to prevent viral transmission. Worldwide, strategies including universal testing and the roll-out of ART have reduced transmission, and the number of new diagnoses is falling. In the UK, however, approximately 1 in 4 individuals with HIV are unaware of their diagnosis, and nearly half present with a CD4 count <350 cells/microlitre. It remains essential that all healthcare providers are alert to at the risk of HIV, and those who display the signs of early infection, to ensure these patients are tested and treatment is put in place before the development of HIV-related infections, cancers and complications.