HIV/AIDS

In the early 1980s, an unusual collection of clinical entities appeared that were characterized by aggressive opportunistic infections and malignancies in otherwise healthy individuals. These individuals also demonstrated a severe compromise of immune defense mechanisms. The disease was universally fatal. This complex syndrome of signs and symptoms was labeled as acquired immunodeficiency syndrome (AIDS). Within several years, the agent responsible for the disease (a single-strand RNA virus labeled human immunodeficiency virus, or HIV) was identified by several different research groups. The virus selectively infects a cell line in a person's immune defense mechanism (T-helper cells) that is critical for successful detection of infection, elimination of organisms causing certain infections, or removal of potential tumor cells. HIV, a spectrum disease, progresses in stages. First, shortly after infection, there are mild flu symptoms. This is followed by an asymptomatic phase, which may give rise to symptoms resulting from destruction of the immune defense mechanisms, including opportunistic infections and malignancies (usually within 10 to 15 years). Therefore, a person's ultimate demise is not from HIV per se but instead from the consequences of the ability of the virus to destroy the host's immune defense mechanisms. In all phases of the disease, the same inexorable deterioration of immune system is fueled by HIV.

In the not-too-distant past, a diagnosis of HIV/AIDS in the United States was considered tantamount to death. More recently, however, early diagnosis, aggressive treatment, and the advent of drug combinations have transformed HIV/AIDS into a chronic condition that may afford individuals longevity long after diagnosis. In particular, those who can afford and have access to medications and who adhere to treatment regimens have higher rates of survival than ever before. This increased longevity for HIV/AIDS patients is paralleled by a rise in psychosocial issues related to AIDS survivorship.

It should be considered that while the picture in developed nations is improving with regard to prevention and survival, this is not the case in developing nations or those for whom access to medical care for HIV/AIDS is restricted. Although HIV/AIDS is a disease found throughout the world, there is a very high prevalence in sub-Saharan Africa, and a rapidly increasing prevalence in the Indian subcontinent and the countries making up the former Soviet Union. Moreover, there is a shift occurring in the epidemiology of HIV/AIDS; for example, in the United States the number of AIDS/HIV cases attributable to heterosexual contact with what would be considered non-high-risk partners surpasses the number of cases attributable to heterosexual contact with high-risk partners. Women are becoming increasingly vulnerable in that they account for about 44% of AIDS cases worldwide. In addition, the infection rate for African Americans and Latinos is significantly proportionately higher than the rate for Caucasians in the United States.

For those patients who are fortunate enough to obtain state-of-the-art medical care, however, the resulting increase in longevity has driven the current focus on the importance of the individual's psychological state as a determinant of the success of treatment. Thus, comprehensive treatments for persons with HIV/AIDS include social and psychological services in addition to medical services.

...