The Changing Face of HIV Infection

1the AIDS epidemic has swept the world. In the US, during the intervening 27 years, the demographics of the disease have changed dramatically. What was once a disease of Caucasian MSM has evolved into a disease that increasingly affects women and disproportionately affects people of color. 2 This brief review will examine the demographics of the HIV epidemic as it now exists in the US. Tracking the Epidemic The Centers for Disease Control and Prevention (CDC) has assumed a pivotal role in tracking the spread of the AIDS epidemic. During the early years of the epidemic, the CDC tracked only AIDS cases, defined as: T-cell count less than 200 or development of AIDS-defining opportunistic infections. Given the poor response to HIV therapy in those early years, this method enabled the CDC to estimate with greater accuracy the numbers of people who were infected with HIV because the disease often progressed in a predictable pattern. Beginning in the mid-1990s, however, the era of highly active antiretroviral therapy (HAART) was ushered in with the advent of the protease inhibitors. For the first time, it became possible to control effectively viral replication and forestall the progression of HIV-infested patients to fulminate AIDS. 3