AIDS clinical review最新文献

Despite the continued increase in the number of HIV-1-infected children, there is optimism that with the prospective identification of HIV-1-infected pregnant women, the incidence of infection can be diminished through prevention of mother-to-child transmission both by use of antiretroviral agents as well as by improved obstetrical management. Also, insight into viral dynamics and the advent of more potent antiretroviral agents provides hope for better treatment strategies and thus the ability to slow disease progression of HIV-1-infected children.

HIV infection is characterized by a variety of disturbances in the regulation of cytokine expression. These disturbances include a general decrease in the expression of type 1 T-helper cytokines, an increase in expression of proinflammatory cytokines, a possible increase in type 2 helper cytokines, and increased expression of antiviral interferons and TGF-beta. These perturbations may contribute to HIV disease pathogenesis by contributing to the impaired cellular immune responses and cell loss that characterize HIV infection and AIDS and by accelerating replication of HIV-1. Treatment trials utilizing cytokines and their inhibitors may provide useful adjuncts in the management of HIV-1 disease, and at the same time they can be designed to help clarify the role of cytokine dysregulation in the pathogenesis of HIV-1 disease. Although powerful combinations of antiretroviral drugs can reduce plasma HIV levels below the limits of detection, it is not clear that full immunological reconstitution is a consequence of these interventions. Trials of immune-based therapies, including trials of cytokines and their inhibitors, are therefore an increasingly important component of our treatment research agenda.

The HIV/AIDS epidemic has slowed in growth and is approaching a leveling in incidence. However, the number of HIV-infected persons is high, and new infections continue to occur. The prevention of AIDS-related OIs and decreases in AIDS-related mortality are an encouraging sign that HIV-infected persons are living better and longer lives. However, if the improvements in clinical management and patient survival are not matched by reductions in HIV incidence, the population of HIV-infected persons will increase. The characteristics of persons with HIV infection are changing over time and must be monitored to properly target prevention and care. HIV/AIDS rates are highest for black and Hispanic Americans, and one fifth of persons with AIDS are women. Because of the decreases in HIV incidence and in prevalence for homosexual and bisexual men, an increasing proportion of infections in the United States are related to injecting drug use and heterosexual transmission. The characteristics of persons at risk for HIV infection differ regionally, and prevention efforts must be based on the characteristics of local HIV/AIDS trends. The reduction in the number of children with AIDS and HIV-infected transfusion recipients reflects the impact of an effective prevention intervention. The changes for homosexual and bisexual men and IDUs suggest a reduction in high-risk behaviors since the early years of the epidemic. Behavioral surveys indicate that heterosexual persons in the general population have adopted some protective behaviors, which may explain in part the HIV/AIDS surveillance trends. However, many young homosexual and bisexual men, IDUs, and other heterosexual persons continue to practice behaviors that lead to HIV infection. Further reduction in these risk behaviors and the adoption of protective behaviors among these populations will be necessary to further slow the spread of HIV infection and decrease the number of infected persons.