Acquired immunodeficiency syndrome (AIDS) following infection with human immunodeficiency virus (HIV) was brought to the world's attention in 1981, with the first case reports of Pneumocystis carinii pneumonia (PCP) in homosexual men in Los Angeles. These reports were quickly followed by descriptions of Kaposi's sarcoma (KS) in similar patient groups. There followed a cornucopia of opportunistic infections and isolated reports of high-grade B-cell non-Hodgkin's lymphomas (NHL), both primary cerebral lymphomas and systemic NHL. By 1985, high-grade B-cell NHL was included along with KS as an AIDS-defining illness by the Centers for Disease Control (CDC), following the publication of a series of 90 homosexual men with NHL.1 A number of other cancers occur at an increased frequency in people with HIV infection, including Hodgkin's lymphoma, anal cancer, lung cancer, and testicular seminoma23; however, these malignancies have not been included in the definition of AIDS. In addition, an increased incidence of multicentric Castleman's disease (MCD) has been found in people with HIV, following the recognition of an association between MCD and AIDS-associated KS.4'5 Studies by the World Health Organization have shown that by December 2003, over 20 million people had died of AIDS and 42 million people were living with the virus. The number of people newly infected with HIV is approximately 6 million per year.6
Dramatic improvements in the antiviral therapy of HIV infection occurred in the second half of the 1990s which have altered the natural history of HIV infection in those economies where these medicines are widely available. The introduction of highly active antiretroviral therapy (HAART) has led to a fall in the incidence of both opportunistic infection and AIDS-associated malignancies. The development of effective antiretroviral therapies commenced with the introduction of nucleoside reverse transcriptase inhibitors starting with zidovudine in 1987. In the last 8 years, three new classes of antiretroviral agents have been introduced: protease inhibitors (PIs) (saquinavir, indi-navir, ritonavir, nelfinavir, and lopinavir), non-nucleo-side reverse transcriptase inhibitors (nevirapine, delavirdine, and efavirenz), and fusion inhibitors (enfuvirtide). The introduction of the first two classes in the late 1990s led to the use of combination HAART. HAART has had an enormous impact on the treatment of HIV in terms of overall survival, incidence of opportunistic infections, and quality of life. In randomized studies, HAART led to a dramatic decline in the mortality and morbidity of HIV.7 However, only 1 million of the estimated 42 million people infected with HIV worldwide are receiving HAART, as the majority of affected people live in developing countries. In addition, even in the established market economies with access to medical treatment, many individuals remain undiagnosed and consequently do not receive HAART.
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