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The spread, treatment, and prevention of HIV-1: evolution of a global pandemic
Myron S. Cohen, … , Kevin DeCock, Joep Lange
Myron S. Cohen, … , Kevin DeCock, Joep Lange
Published April 1, 2008
Citation Information: J Clin Invest. 2008;118(4):1244-1254. https://doi.org/10.1172/JCI34706.
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Review Series

The spread, treatment, and prevention of HIV-1: evolution of a global pandemic

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Abstract

The most up-to-date estimates demonstrate very heterogeneous spread of HIV-1, and more than 30 million people are now living with HIV-1 infection, most of them in sub-Saharan Africa. The efficiency of transmission of HIV-1 depends primarily on the concentration of the virus in the infectious host. Although treatment with antiviral agents has proven a very effective way to improve the health and survival of infected individuals, as we discuss here, the epidemic will continue to grow unless greatly improved prevention strategies can be developed and implemented. No prophylactic vaccine is on the horizon. However, several behavioral and structural strategies have made a difference — male circumcision provides substantial protection from sexually transmitted diseases, including HIV-1, and the application of antiretroviral agents for prevention holds great promise.

Authors

Myron S. Cohen, Nick Hellmann, Jay A. Levy, Kevin DeCock, Joep Lange

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Figure 1

Source of infections with HIV-1 by region.

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Source of infections with HIV-1 by region.
An individual can become infe...
An individual can become infected with HIV-1 from many sources, including contaminated blood and blood products (such as though medical injections, blood transfusions, and injection drug usage [IDU]), an infected mother transmitting the virus to her baby (before, during, or after birth and through breast milk), and through either vaginal or anal intercourse. The relative importance of a source of HIV-1 varies in different parts of the world. In some countries, infection with HIV-1 is mainly detected in specific groups at risk, including MSM, injecting drug users, sex workers, and the regular partners of such persons. In most countries of sub-Saharan Africa, however, HIV-1 is self-sustaining in the general population through heterosexual intercourse in HIV-serodiscordant couples. MTCT, mother-to-child transmission. The data presented here were mostly generated for 2005, but some data are from earlier years. Reproduced with permission from the Global HIV Prevention Working Group (103).

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ISSN: 0021-9738 (print), 1558-8238 (online)

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