PRIMEVIEW

HIV INFECTION
For the Primer, visit doi:10.1038/nrdp.2015.35

More than 30 million people MANAGEMENT

worldwide are infected with human
immunodeficiency virus (HIV). HIV is a
retrovirus (its genetic material is RNA) and
two main types are known: HIV-1, which
is responsible for the vast majority of the
global burden of disease, and HIV-2.
EPIDEMIOLOGY
PREVENTION Condom use is an effective method to prevent sexual
transmission of HIV when used consistently. Other
aspects of prevention include using antiretroviral therapy Antiretroviral therapy is at the centre of HIV
Mother-to-child
transmission to prevent mother-to-child transmission. Uninfected care. These drugs target many aspects of the
Antiretroviral therapy,
individuals can use therapy to prevent HIV acquisition. HIV life cyle: viral entry into the cells, reverse
caesarean section delivery and
formula feeding can eliminate transcription, integration of viral DNA into
transmission the host and protein maturation. When used
optimally, therapy can control HIV replication
for decades. Protease
inhibitors

HIV is transmitted through contact with blood,

semen and pre-seminal fluid, vaginal and rectal Post-exposure prophylaxis
fluids and breast milk. In all regions of the world, For people who are
exposed, immediate start
at-risk populations include men who have sex with of antiretroviral therapy Attachment
men, intravenous drug users, people living in closed can block the few infected inhibitors
settings (such as prisons) and sex workers — all of cells from amplifying
the virus
whom have complex legal and social issues that
Treatment as prevention
increase vulnerability. Globally, but particularly For HIV-positive individuals, Fusion Integrase
in sub-Saharan Africa, women are at risk through remaining on antiretroviral inhibitors strand transfer
therapy reduces the risk inhibitors
heterosexual transmission from a partner with an of transmission
unknown or undisclosed HIV status. As a result of Nucleoside and non-nucleoside
reverse transcriptase inhibitors
massive global efforts to control the HIV epidemic,
global incidence declined by 35% from 2000 to 2014. +
HIV
Medical OUTLOOK
circumcision has
MECHANISMS been shown to reduce Pre-exposure prophylaxis The 90-90-90 goals delineated by the global
acquisition rates by For high-risk individuals,
50–60% antiretroviral therapy can help community and endorsed by the United Nations
HIV primarily infects CD4+ T cells, attacking to reduce the likelihood of Joint Programme on HIV/AIDS aim that, by 2020,
acquiring the virus
these cells in the lymphoid tissues. Within weeks 90% of people with HIV infection will be diagnosed,
of infection, most of the CD4+ T cells in the that 90% of those people will receive antiretroviral
gut-associated lymphoid tissue are depleted. therapy and that 90% of those people will achieve
HIV can also harm the bone marrow and thymus, viral suppression. To achieve this ambitious feat,
which prevents T cell regeneration. Loss of DIAGNOSIS QUALITY OF LIFE multidisciplinary efforts are required. Improved
CD4+ T cells leads to immunodeficiency, excess treatment regimens (such as long-acting
pathogen load and chronic inflammation. This Several diagnostic assays are available for HIV Active HIV replication is associated with malaise, antiretroviral drugs), adherence education,
results in a complex immunological syndrome: testing, some of which can provide a result within fever, weight loss and a multitude of symptoms. preventive vaccines
acquired immune deficiency syndrome (AIDS). 30 minutes. However, positive findings or cases of Antiretroviral therapy often has adverse and strategies A major problem with
Antiretroviral therapy can prevent and at least suspected acute infection must be followed-up effects and can cause drug–drug interactions. to eliminate the HIV management
partially restore any damage to the immune with confirmatory tests. Co-morbidities such as heart disease and cancer latent viral reservoir globally is barriers to
system. Despite therapy, the virus persists are common in people with HIV infection. The form the foundation care: not everyone
indefinitely, residing as integrated DNA in host stigma associated with being HIV-positive of the current with the virus is on
long-lived resting memory CD4+ T cells. remains a major concern for many individuals. research activity. antiretroviral therapy

Designed by Laura Marshall Article number: 15060; doi:10.1038/nrdp.2015.60; published online 1 October 2015
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