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As we celebrate the 27th annual World AIDS Day, it is encouraging to note the most recent trends of worldwide reductions in new HIV infections and AIDS-related deaths. However, the gains charted against the “disease that changed everything” are not equally distributed. In fact, the HIV/AIDS crisis has markedly widened gaps of inequality in health and wellbeing the world over.

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Does it matter when the first blood transfusion occurred in Africa? If we are to believe the Serial Passage Theory of HIV emergence, then sometime in the early twentieth century.

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World AIDS Day is a global campaign that raises awareness and funds for the estimated 34 million people living with HIV, and also commemorates the 35 million people who have died of the virus. The first one was held in 1988 and, as such, it is the longest running health day. Despite many medical advances, HIV remains one of the most devastating epidemics in human history. The search for a cure or vaccine for HIV continues, with new discoveries being published all the time. We’ve created a reading list of journal articles and books so that you can read some of the latest, cutting-edge texts on the subject:

‘Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice‘, published in International Health
This article investigates the extent to which HIV-1 infection is considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014.

‘Delivering TB/HIV services in Ghana: a comparative study of service delivery models‘, published in Transactions of the Royal Society of Tropical Medicine & Hygiene
Three hospitals with different delivery models were identified and a survey of TB cases registered between June 2007 and December 2008 conducted.

‘HIV and HIV treatment: effects on fats, glucose and lipids‘, published in British Medical Bulletin
This review provides a brief summary of our current understanding of the epidemiology, clinical presentation and therapeutic approaches of what is termed ‘the HIV-associated lipodystrophy syndrome’ and of HIV-associated lipid and glucose metabolic abnormalities.

‘Increased Morbidity in Early Childhood Among HIV-exposed Uninfected Children in Uganda is Associated with Breastfeeding Duration’, published in Journal of Tropical Pediatrics
Studies in Sub-Saharan Africa have shown that HIV-exposed uninfected children (HEU) have an increased risk of morbidity and mortality compared with HIV-unexposed uninfected children (HUU). This article looks at how breastfeeding affects the relationship between HIV-exposure and morbidity and mortality.

‘Randomized community-level HIV prevention intervention trial for men who drink in South African alcohol-serving venues’, published in European Journal of Public Health
South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. Read the study in full

‘Primary Effusion Lymphoma (PEL) in the absence of HIV infection – Clinical presentation and management’, published in QJM
To clarify treatment issues in HIV-negative PEL patients, this report looks at two such patients who represent two opposing ends in the spectrum of treatment and review the literature regarding treatment options and patient outcomes.

‘Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults’, published in Age and Ageing
The number and proportion of adults diagnosed with HIV infection aged 50 years and older has risen. This study compares the effect of CD4 counts and anti-retroviral therapy (ART) on mortality rates among adults diagnosed aged ≥50 with those diagnosed at a younger age.

‘Attitudes about providing HIV care: voices from publicly funded clinics in California’, published in Family Practice
As the enactment of health care reform becomes a reality in the USA, it has been widely predicted that HIV+ patients will increasingly be cared for by primary care physicians (PCPs), many of whom lack the experience to deliver full-spectrum HIV care.

‘Community-based family-style group homes for children orphaned by AIDS in rural China: an ethnographic investigation’, published in Health Policy and Planning
As the number of children orphaned by AIDS (Acquired Immunodeficiency Syndrome) has reached 17.3 million, most living in resource-poor settings, interest has grown in identifying and evaluating appropriate care arrangements for them.

‘Physician communication behaviors from the perspective of adult HIV patients in Kenya’, published in International Journal for Quality in Health Care
This study looks at the perceived physician communication behaviors and its association with adherence to care, among HIV patients in Kenya.

‘Glycodendrimers prevent HIV transmission via DC-SIGN on dendritic cells’, published in International Immunology
The authors design molecules that bind dendritic cells and block HIV-1 binding, thereby stopping transport to CD4+ T cells and preventing virus transmission.

‘Clinical Outcomes of AIDS-related Burkitt Lymphoma: A Multi-institution Retrospective Survey in Japan’, published in Japanese Journal of Clinical Oncology
Highly intensive chemotherapy would bring a high remission rate and prolonged overall survival for patients with AIDS-related Burkitt lymphoma.

‘Interview with Dr. Deborah Cotton about HIV Treatment and the Early Years of the Epidemic’, published in Open Forum Infectious Diseases
In this podcast, Editor-in-Chief Paul Sax, MD, speaks with colleague Deborah Cotton, MD, MPH, about the recent OFID article “A Glimpse of the Early Years of the Human Immunodeficiency Virus Epidemic: A Fellow’s Experience in 2014.” Drs. Sax and Cotton compare their experiences in Boston with those of the authors at Atlanta’s Grady Hospital, which still cares for a large number of patients with untreated HIV

‘Improvements in HIV Care Engagement and Viral Load Suppression Following Enrollment in a Comprehensive HIV Care Coordination Program’, published in Clinical Infectious Diseases
Gaps in the HIV care continuum jeopardize the success of the National HIV/AIDS Strategy. A pre-post analysis of 1-year outcomes among New York City Ryan White Care Coordination clients demonstrated improvements in HIV care engagement and viral suppression.

‘Frailty in People Aging With Human Immunodeficiency Virus (HIV) Infection’, published in The Journal of Infectious Diseases
The increasing life spans of people infected with HIV reflect enormous treatment successes and present new challenges related to aging. This review explains how frailty has been conceptualized and measured in the general population, critically reviews emerging data on frailty in people with HIV infection, and explores how the concept of frailty might inform HIV research and care.

‘Factors Associated With Retention Among Non–Perinatally HIV-Infected Youth in the HIV Research Network’, published in Journal of the Pediatric Infectious Diseases Society
The transmission of HIV among youth through high-risk behaviors continues to increase. Retention in care is associated with positive clinical outcomes and a decrease in HIV transmission risk behaviors, but this retrospective analysis shows alarmingly high proportions of newly enrolled non-perinatally HIV-infected youth were not retained.

‘Sex differences in atazanavir pharmacokinetics and associations with time to clinical events: AIDS Clinical Trials Group Study A5202′, published in Journal of Antimicrobial Chemotherapy
This new research from the Journal of Antimicrobial Chemotherapy examines whether HIV-1 antiretroviral exposure and clinical response varies between males and females. The study of 786 participants revealed that average atazanavir clearance was slower in females than males.

Oxford Textbook of Medicine, edited by David A. Warrell, Timothy M. Cox, and John D. Firth
Giving an unparalleled integration of HIV/AIDS basic science and clinical practice, this chapter is taken from the Oxford Textbook of Medicine, the most comprehensive, authoritative, and international medical textbook available.

Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health, edited by Richard Pattman, Nathan Sankar, Babiker Elawad, Pauline Handy, and David Ashley Price
Taken from the Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health, this chapter provides evidence based, practical information on HIV/AIDS and details the pathogenesis of HIV infection.

Fitness For Work, edited by Keith T Palmer, Ian Brown, and John Hobson
Comprehensive coverage of occupational health issues relating to HIV. While antiretroviral treatment (ART) has increased survival, many HIV-infected people remain symptomatic, either through drug side effects, HIV-related illnesses, or the psychological morbidity associated with the diagnosis and disease. All of these factors can have a significant effect on an individual’s ability to find, and remain in, work.

Oxford Handbook of Tropical Medicine, edited by Andrew Brent, Robert Davidson, and Anna Seale
This guide to HIV is from the Oxford Handbook of Tropical Medicine, a definitive resource for medical problems in tropical regions, and low-resource countries. Covering diagnosis and associated diseases, through to treatment and prevention strategies, this chapter is a comprehensive guide to clinical practice.

Challenging Concepts in Infectious Disease, edited by Amber Arnold and George Griffin
Part of a compendium of challenging cases, this chapter examines prevention of mother-to-child HIV transmission in a case where a 26-year-old Nigerian lady presented with a week-long history of worsening fever, cough, and shortness of breath. She was 28 weeks into her first pregnancy, which had otherwise been uneventful and had included a negative routine antenatal test for HIV at 12 weeks’ gestation.

Virus Hunt, by Dorothy H. Crawford
The hunt for the origin of the AIDS virus began over twenty years ago. It was a journey that went around the world and involved painstaking research to unravel how, when, and where the virus first infected humans.

The Aids Generation, by Perry Halkitis
Perry Halkitis narrates a story of HIV survival, based on his interviews with the AIDS Generation, those gay men who came of age at the onset of the epidemic, prior to any effective treatments. This chapter provides a historical and epidemiological background of the HIV/AIDS epidemic as it has manifested itself over the last three decades.

African Health Leaders, edited by Francis Omaswa and Nigel Crisp
Written by Africans, who have themselves led improvements in their own countries, the book discusses the creativity, innovation and leadership that has been involved tackling everything from HIV/AIDs, to maternal, and child mortality and neglected tropical diseases.

Featured image credit: World AIDS Day, White House, by tedeytan. CC-BY-SA-2.0 via Flickr.

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1 December is World AIDS Day. Here Kenneth Mayer, MD, explains what makes the 2012 observance different from all those before – and, hopefully, those to come. Dr. Mayer is Co-Editor of Clinical Issues in HIV Medicine, Co-Chair of the HIVMA/IDSA Center for Global Health Policy’s Scientific Advisory Committee, founding Medical Research Director of Fenway Health, a visiting professor at Harvard Medical School, and an attending physician and director of HIV Prevention Research at Beth Israel Deaconess Hospital in Boston.

By Kenneth Mayer

Last year, on World AIDS Day, U.S. President Barack Obama set ambitious goals to reach more people with treatment and fundamental prevention. Echoing U.S. Secretary of State Hillary Clinton’s call for an “AIDS-free generation,” he envisioned a tipping point in a 30-year battle to subdue the world’s costliest epidemic.

This World AIDS Day, the administration’s release of a global AIDS roadmap takes the vision into practice. Outlining the U.S. government’s commitment to apply research to reality, with the efforts of affected countries and other donors, it is as much a promise as a challenge.

The plan serves as a solid indication that three decades into a struggle that began without direction, and that sometimes seemed futile, the U.S. has set a course to continue the pace it has achieved in the last year, while giving partners encouragement and reason to match those efforts. It underscores, at a time of worldwide economic challenges and competing concerns, that this investment will yield gains, this is a battle that can be won, and this is not the time to stand still.

The global health community and its researchers, policy makers, donors, field workers, and affected populations know what to do to begin to end this epidemic, and now need to do it. To realize the magnitude of this opportunity, compare where we are now to where we were 31 years ago when fear, ignorance, and prejudice stymied responses while AIDS’ death toll multiplied exponentially as it circled the world. With little clue as to how the virus was transmitted from 1981 to 1985 rumors and mistrust also spread. Through epidemiological research we overcame the terror of those years, understanding that without blood exchange or intimate sexual contact the virus was not readily transmitted. Researchers’ discovery in the mid-1990s that combinations of antiretroviral drugs could arrest the virus changed it from a death sentence into a manageable disease, for many. Shamefully, the cost of those drugs kept the benefit of that breakthrough from being shared in the poor countries where relief was most needed. Finally, in the last decade, with the importation of generic medicines, the establishment of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief, work to confront the epidemic emerged from laboratories and wealthy countries, to what are now some of the most formidable front lines.

Yet we continue to fall short. We know that injection drugs are a major vector for HIV transmission, but many countries punish users of those drugs rather treat them with opioid substitution therapy and protect them with needle exchange programs. Homophobia and criminalization of gay sex threaten efforts to even count the toll in countries where HIV is most prevalent. Programs to prevent transmission of the virus from mothers to infants are hobbled by constraints on family planning commodities. Sex workers are marginalized by efforts that exclude their input. Treatment and prevention programs fail to reach people with physical and mental disabilities. While tuberculosis is the primary killer of people living with HIV, screening and treatment for the two diseases remain unlinked. While donors have imported some of the means to fight the epidemic, too often they have imported answers as well, failing to allow for the diversity of needs and affected populations in different countries.

With a plan that includes the needs of all affected populations, the tools we have now will be powerful. The study known as HPTN 052 showed that early initiation of antiretroviral therapy could decrease the transmission of HIV in couples in which only one partner was HIV-positive by 96 percent. The use of an antiretroviral drug as pre-exposure prophylaxis in combination with other risk-reduction measures, was shown to be effective in protecting men who have sex with men, and heterosexual men and women from acquiring the virus.

These discoveries will be useless, however, if people who need medicine to save their lives don’t get it. While eight million people are getting treatment, 34 million are living with the virus. Maintaining the momentum of treatment coverage that the U.S. has achieved in the last year in Africa is imperative to meet the original humanitarian mission of the response as well as to continued progress.

Then, with shared responsibility and political will, the next World AIDS Day can be one on which we can see the end of the road, far ahead but certain, when we can stop the further spread of HIV.

To raise awareness of World AIDS Day, Dr. Mayer and Daniel Kuritzkes, MD (Co-Editor of Clinical Issues in HIV Medicine) have selected recent, topical articles, which have been made freely available for a limited time by  The Journal of Infectious Diseases and Clinical Infectious Diseases. Both journals are publications of the HIV Medicine Association and the Infectious Diseases Society of America.

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Image credits: World AIDS Day press images via worldaidsday.org media centre.

On World AIDS Day 2011, we speak with Dr Martin S. Hirsch, MD, FIDSA to find out the latest news on the global fight against AIDS. Dr. Hirsch is editor-in-chief of The Journal of Infectious Diseases, professor of medicine at Harvard Medical School, professor of infectious diseases and immunology at the Harvard School of Public Health, and a physician at Massachusetts General Hospital. – Nicola

Q: Thirty years after the first reports of AIDS, why is HIV/AIDS research still important?
A: Although we have made enormous progress in developing effective combination antiretroviral therapies to control HIV infection, we have been far less successful in preventing infection. Thus, in the US, as well as in the rest of the world, there are more people living with HIV infection today than ever before; worldwide, this number is over 30 million. Many individuals who are infected do not know that they are and, thus, they continue to spread virus to contacts by sexual contact, needle sharing, or mother-to-child transmission. We are not near having an effective preventative HIV vaccine, nor is a cure for those already infected on the immediate horizon. The risk of emerging drug-resistant viruses is also always with us. For all these reasons and more, it is essential that research efforts continue until we can say that HIV has been eradicated or is no longer a public health problem in the world.

Q: What notable important discoveries or research findings have there been in the field recently?
A: In my view, the most notable research advances in the field recently have been in efforts to prevent new HIV infections by using treatment as prevention and pre-exposure prophylaxis. Studies published this year by Myron Cohen and colleagues have shown in placebo-controlled studies that by treating HIV-infected members of discordant couples (one infected, one not), new infections can be reduced by up to 96 percent. This emphasizes the need for early recognition of infections and early treatment. It has also been established that pre-exposure prophylaxis with antiretroviral drugs can reduce transmission in high-risk populations, whether they be heterosexual or men who have sex with men. Pre-exposure prophylactic regimens have taken the form of oral therapy or topical administration of vaginal microbicides. The challenge now is to find ways to implement these strategies worldwide to prevent new infections in cost-effective ways.

Q: What should the public take away from these findings?
A: The public should be aware that only by early recognition of infection can we reduce the scourge of continued HIV transmission and disease. The US Centers for Disease Control and Prevention and other organizations have indicated the need for more routine testing of all populations who enter medical care in the US, and gradually our states and other public health authorities are implementing these suggestions. Nevertheless, there are still thousands of individuals in the US and millions in the world who do not know they are infected and who continue to spread virus. The public should insist on more HIV testing with appropriate measures to protect confidentiality among those tested. It is also critical that efforts to make effective therapies available to those in need not be curtailed in these times of budget stringency. Cuts at this time would reap bitter harvests in years to come.

Q: What do you see as the priority areas for future HIV/AIDS research? Where will the next great advances be?
A: There are several priority areas for HIV research in the years ahead. These include:

- Continued efforts to develop safe and effective prophylacti

World AIDS Day on BET (music countdown show, 106 & PARK, dedicates a full episode to the growing HIV/AIDS epidemic, along with other weeklong programming events. Also Alicia Keyes performs live on YouTube as global ambassador for Keep a Child... Read the rest of this post