British Medical Bulletin 58:1-2 (2001)
© 2001 The British Council
Preface
It is now 20 years since acquired immune deficiency syndrome (AIDS) was first recognised as a novel disease. Since then, it has burgeoned from a few sentinel cases among ‘high risk’ groups to become a world-wide pandemic. Some 22 million people have died as a result of AIDS and over 37 million women, men and children are currently infected with the human immunodeficiency virus (HIV). The epidemic has left behind a cumulative total of over 13 million orphans. Traditional family structures and extended families are breaking down under the strain of HIV. Population growth and death rates are increasingly affected. Life expectancies in countries with adult prevalences of over 10% (e.g. Botswana, Kenya, Zimbabwe, South Africa, Zambia, Rwanda) are expected to see an average reduction of 17 years by 2010–2015. Young, highly productive adults die at the peak of their output which has considerable impact on a country's economy.
HIV actually constitutes two distinct types of lentivirus, HIV-1 and HIV-2, which have a slightly different genetic make-up and different origins. HIV-1 is further classified into three major groups, M, N and O. Group M, which represents the global spread of HIV, comprises numerous subtypes or clades, A to H, that have blossomed in different geographic regions. Both HIV-1 and HIV-2 are new infections to humankind. HIV-1 is thought to have crossed host species to humans from chimpanzees, whereas HIV-2 clearly comes from sooty mangabey monkeys. Both types of HIV cause AIDS with essentially the same symptoms of disease, but a higher proportion of those infected with HIV-2 appear to survive as long-term non-progressors.
There has been rapid progress in our medical and scientific understanding of AIDS and HIV. Within 2 years of noting AIDS as a distinctive syndrome in 1981, HIV-1 was identified, and within a year of learning how to propagate the virus, experimental serological research had been developed into reliable and robust diagnostic tests for blood screening. By late 1985, all industrialised countries had instituted universal screening of blood and tissue donors. The first anti-HIV drug started clinical trials in 1986 and, since 1996, combination anti-retroviral therapy has resulted in a 67% fall in AIDS mortality among those HIV-infected persons who had access to treatment. On the other hand, progress in translating immunological and virological research into a safe, efficacious vaccine has not yet matched the progress in treatment.
HIV/AIDS has emerged to become the overwhelming health issue confronting the world today. Daunting medical, social and economic problems remain in designing, delivering and implementing preventive measures to curb the HIV pandemic. In the following pages, leading investigators of HIV and AIDS present authoritative overviews on the nature of HIV, its epidemiology and pathogenesis, on the medical and social impact of intervention, treatment and prevention. We are grateful to them all for presenting an up-to-date and balanced account of the changing face of HIV and AIDS.
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