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  • Title: The epidemiology of the acquired immunodeficiency syndrome in the 1990s.
    Author: Quinn TC.
    Journal: Emerg Med Clin North Am; 1995 Feb; 13(1):1-25. PubMed ID: 7851311.
    Abstract:
    Since the recognition of AIDS in 1981, it has become a global pandemic afflicting more than 6 million people worldwide. To date, more than 22 million people are infected with HIV-1, the cause of AIDS, and more than 40 million people may be infected with HIV by the year 2000. In the United States, AIDS has become the leading cause of death in young men and the fourth leading cause of death in young women. HIV is primarily transmitted sexually, parenterally, and perinatally, with increasing evidence of heterosexual transmission in the United States and worldwide. Factors associated with transmission and susceptibility to HIV are discussed, and the natural history of HIV and means of intervention are detailed in this article. Three key modes of HIV transmission account for most HIV infections. They are sexual transmission, parenteral transmission, and perinatal transmission. Initially, homosexual transmission was the leading mode of HIV transmission in developed countries. Heterosexual transmission predominates in developing countries and is becoming more common in developed countries. 70% of all HIV infected persons worldwide are from sub-Saharan Africa. By January 1994, 86% of all AIDS deaths were in sub-Saharan Africa. Southeast Asia has had the most rapid growth of HIV infection during the 1990s. The number of HIV infected persons in Southeast Asia is greater than the total number of HIV infected persons in all developed countries. The US has the highest official number of AIDS cases in the world (by January 1994, 361,509 cases and 220,871 deaths). AIDS has become one of the leading causes of death for persons aged 25-44. In 1993, the increase in AIDS cases was greater among women than men and greater among Blacks and Hispanics than Whites. The greatest increase was among youth aged 13-19 and 20-24. Between 1992 and 1993, AIDS cases attributed to heterosexual activity increased 130%, while those attributed to homosexual activity fell from 66.5% to 46.6%. Risk factors are number of sex partners, frequency of unprotected sexual contact, anal intercourse, prostitution, sex with a prostitute, a history of sexually transmitted diseases (STDs), and, in the index case, level of CD4 lymphocytes, level of plasma viremia, use of antiretroviral therapy, genital ulcers or other STDs, no circumcision, or cervical ectopy. Zidovudine therapy during pregnancy reduces perinatal HIV transmission. Transmission of HIV through household contact is rare. HIV disease has five stages based on the CD4 count: acute infection, early disease, middle disease, late disease, and advanced disease. Symptoms within two to six weeks of exposure to HIV are fever, adenopathy, pharyngitis, and a transient skin rash. Risk reduction behavior is needed to prevent and control HIV disease.
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