CRC OUTPAT MGMT HIV INFCTN PDF

Preface

The HIV/AIDS epidemic continues to advance on both old and new fronts. More than previously, however, two distinct epidemics can now be discerned. Because of great improvements in therapy, promising trends have emerged in the United States and other developed countries. New cases and death rates have fallen steadily since the mid-1990s. Where systems of care permit, countless patients have seen a reversal of HIV-related symptoms and significant reconstitution of their immune systems because of effective antiretroviral therapy. New childhood HIV infections have been reduced almost to the vanishing point in the United States, and the image of AIDS as a uniformly lethal disease has been largely transformed in the public mind to that of a chronic, but treatable, disorder. Unfortunately, this transformation has been so profound that, in some circles, it has fueled an increase in high-risk sexual activity.

In stark contrast is the situation in the developing world where an ever-increasing proportion of the world's AIDS occurs. As the number of infected individuals in Africa has exceeded even the most nightmarish predictions of a few years ago, the countries of South Asia, Central Asia, and Eastern Europe have witnessed an acceleration of their regional epidemics.

Why has the epidemic followed these two divergent paths? In developed countries possessing the resources to fund comprehensive systems of care, development and distribution of, and reimbursement for effective drugs to combat the disease, HIV/AIDS has, at least partially, retreated. But the enormous dedication of funds and the availability of a versatile and effective healthcare apparatus required to accomplish this are far out of reach for most of the countries of the world, including those most devastated by AIDS. Education regarding risk avoidance and, specifically, "safe sex" practices has met with much success in the developed world but, often, with cultural taboos and simple lack of resources to support behavioral change in the developing world.

In all this there is good news and there is very bad news. The good news is that with a concentrated effort, societies can effectively combat this terrible modern plague. The bad news is that such an effort is beyond the capacity of many individual governments and cooperative measures are in their infancy. As long as this situation prevails, the devastation will continue on a scale that was unimaginable 20 years ago when an unusual syndrome of immune deficiency was first described in a small number of homosexual men in New York and California and first dubbed the acquired immune deficiency syndrome.

The challenge of AIDS is complex and multifaceted. Knowledge is accumulating at a remarkable rate. An informed, compassionate practitioner remains the most important ally for the HIV-infected individual attempting to navigate the complex medical and social issues inherent in this disease. It is hoped that this book will be of assistance to those who have accepted this challenge and responsibility.