View source for HIV/AIDS

{{Short description|Spectrum of conditions caused by HIV infection}}
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{{About|the infectious disease|the virus that causes the disease|HIV}}{{Redirect2|AIDS|Aids}}
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{{Use American English|date=September 2024}}
{{Use mdy dates|date=September 2024}}
{{Infobox medical condition (new)
| name          = HIV/AIDS
| image         = Red_Ribbon.svg
| image_size    = 220
| caption       = The [[red ribbon#AIDS awareness origin|red ribbon]] is a [[awareness ribbon#Awareness Ribbon origin|symbol]] for [[solidarity]] with [[HIV-positive people]] and those living with AIDS.<ref>{{cite web |title=Wear your red ribbon this World AIDS Day |url=http://www.unaids.org/en/resources/presscentre/featurestories/2006/november/20061130redribbonen |website=[[UNAIDS]] |access-date=September 10, 2017 |archive-url=https://web.archive.org/web/20170910221331/http://www.unaids.org/en/resources/presscentre/featurestories/2006/november/20061130redribbonen |archive-date=September 10, 2017 |url-status=live }}</ref>
| alt           = A red ribbon in the shape of a bow
| field         = [[Infectious disease (medical specialty)|Infectious disease]], [[immunology]]
| synonyms      = HIV disease, HIV infection<ref name=AIDS2010GOV/><ref name=AETC-staging>{{cite web |title=HIV Classification: CDC and WHO Staging Systems |url=https://aidsetc.org/guide/hiv-classification-cdc-and-who-staging-systems |website=AIDS Education & Training Center Program |access-date=September 10, 2017 |archive-url=https://web.archive.org/web/20171018065658/https://aidsetc.org/guide/hiv-classification-cdc-and-who-staging-systems |archive-date=October 18, 2017 |url-status=dead }}</ref>
| symptoms      = {{Plain list|
* '''Early''': Flu-like illness<ref name=WHO2015Fact/>
* '''Later''': [[Large lymph nodes]], fever, weight loss<ref name=WHO2015Fact/>
}}
| complications = [[Opportunistic infection]]s, [[Neoplasm|tumors]]<ref name=WHO2015Fact/>
| onset         = 
| duration      = Lifelong<ref name=WHO2015Fact/>
| causes        = [[Human immunodeficiency virus]] (HIV)<ref name=WHO2015Fact/>
| risks         = [[Condom|Unprotected]] [[Anal sex|anal]] or [[Sexual intercourse|vaginal sex]], having another [[sexually transmitted infection]], [[needle sharing]], medical procedures involving [[Sterilization (microbiology)|unsterile]] cutting or piercing, and experiencing [[needlestick injury]]<ref name=WHO2015Fact/>
| diagnosis     = [[Blood test]]s<ref name=WHO2015Fact/>
| differential  = 
| prevention    = Using [[Condom|male]] or [[female condom]] during [[Human sexual activity|sex]],<ref name="WHO2024Factsheet">{{cite web|title=HIV and AIDS|url=https://www.who.int/en/news-room/fact-sheets/detail/hiv-aids|publisher=[[World Health Organization]]|date=22 July 2024|access-date=26 October 2024|archive-date=December 24, 2017|archive-url=https://web.archive.org/web/20171224054738/http://www.who.int/mediacentre/factsheets/fs360/en/|url-status=live}}</ref> [[Diagnosis of HIV/AIDS|being tested for HIV]] and [[sexually transmitted infection]]s,<ref name="WHO2024Factsheet"/> having a [[Circumcision and HIV|voluntary medical male circumcision]],<ref name="WHO2024Factsheet"/> [[Needle and syringe programmes|using harm reduction services for people who inject and use drugs]],<ref name="WHO2024Factsheet"/> [[Management of HIV/AIDS|antiretroviral drugs]] (ARVs) (including [[Pre-exposure prophylaxis for HIV prevention|oral Pre-exposure prophylaxis (PrEP) and long acting products]],<ref name="WHO2024Factsheet"/> [[Dapivirine Ring|dapivirine vaginal rings]],<ref name="WHO2024Factsheet"/> injectable long acting [[cabotegravir]], etc.<ref name="WHO2024Factsheet"/> [[post-exposure prophylaxis]] (PEP)<ref name="WHO2024Factsheet"/> [[safe sex]]
| treatment     = Antiretroviral drugs (ARVs)<ref name=WHO2015Fact/>
| medication    = 
| prognosis     = {{Plain list|
* Normal life expectancy with treatment<ref name="WHO2024Factsheet"/>
* 11 years life expectancy without treatment<ref name=UNAIDS2007/>
}}
| frequency     = {{Plain list|
* 71.3–112.8 million total cases<ref name=UN2022/>
* 1.3 million new cases (2022)<ref name=UN2022/>
* 39.9 million living with HIV (2023)<ref name=UN2022/>
}}
| deaths        = {{Plain list|
* 42.3 million total deaths<ref name=UN2022/>
* 630,000 (2023)<ref name=UN2022/>
}}
}}

<!--Definition and symptoms -->
The [[HIV|'''human immunodeficiency virus''' ('''HIV''')]]<ref name="pmid11396444">{{cite journal |vauthors=Sepkowitz KA |title=AIDS – the first 20 years |journal=[[The New England Journal of Medicine]] |volume=344 |issue=23 |pages=1764–72 |date=June 2001 |pmid=11396444 |doi=10.1056/NEJM200106073442306|doi-access=free  | issn=0028-4793 }}</ref><ref>{{cite book |first1=Alexander |last1=Krämer |first2=Mirjam |last2=Kretzschmar |first3=Klaus |last3=Krickeberg |title=Modern infectious disease epidemiology concepts, methods, mathematical models, and public health |date=2010 |publisher=Springer |location=New York |isbn=978-0-387-93835-6 |page=88 |edition=Online-Ausg. |url=https://books.google.com/books?id=Di0_5x82HykC&pg=PA88  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150924081609/https://books.google.com/books?id=Di0_5x82HykC&pg=PA88 |archive-date=September 24, 2015 |url-status=live }}</ref><ref>{{cite book |first=Wilhelm |last=Kirch |title=Encyclopedia of Public Health |date=2008 |publisher=Springer |location=New York |isbn=978-1-4020-5613-0 |pages=676–77 |url=https://books.google.com/books?id=eSPK7-CHw7oC&pg=PA676  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150911141720/https://books.google.com/books?id=eSPK7-CHw7oC&pg=PA676 |archive-date=September 11, 2015 |url-status=live }}</ref> is a [[retrovirus]]<ref>{{cite web |title=Retrovirus Definition |url=https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/634/retrovirus |website=AIDSinfo |access-date=December 28, 2019 |archive-url=https://web.archive.org/web/20191228142824/https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/634/retrovirus |archive-date=December 28, 2019 |url-status=dead}}</ref> that attacks the [[immune system]]. Without treatment, it can lead to a spectrum of conditions including '''acquired immunodeficiency syndrome''' ('''AIDS''').<ref name="CDC21015Bas" /> It is a [[Preventive healthcare|preventable disease]].<ref name="WHO2024Factsheet" /> It can be managed with treatment and become a manageable chronic health condition.<ref name="WHO2024Factsheet" /> While there is no [[cure]] or [[vaccine]] for HIV, [[Management of HIV/AIDS|antiretroviral treatment]] can slow the course of the disease, and if used before significant disease progression, can extend the [[life expectancy]] of someone living with HIV to a nearly standard level.<ref name="WHO2024Factsheet" /><ref name="UN2012Vac">{{cite news |author=UNAIDS |date=May 18, 2012 |title=The quest for an HIV vaccine |url=http://www.unaids.org/en/resources/presscentre/featurestories/2012/may/20120518vaccinesday/ |url-status=live |archive-url=https://web.archive.org/web/20120524051113/http://www.unaids.org/en/resources/presscentre/featurestories/2012/may/20120518vaccinesday/ |archive-date=May 24, 2012 }}</ref> An HIV-positive person on treatment can expect to live a normal life, and die with the virus, not of it.<ref name="CDC21015Bas" /><ref name="UN2012Vac" /> Effective [[#Treatment|treatment]] for [[HIV-positive people]] (people living with HIV) involves a life-long regimen of medicine to suppress the virus, making the [[viral load]] undetectable.  

Treatment is recommended as soon as the diagnosis is made.<ref name="WHO2015Tx">{{cite book |url=http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1 |title=Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV |date=2015 |publisher=World Health Organization |isbn=978-92-4-150956-5 |page=13 |archive-url=https://web.archive.org/web/20151014071803/http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1 |archive-date=October 14, 2015 |url-status=live }}</ref> An HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually.<ref name="CDCUndetectable">{{cite web |url=https://www.cdc.gov/hiv/library/dcl/dcl/092717.html |title=Dear Colleague: September 27, 2017 |last1=McCray |first1=Eugene |last2=Mermin |first2=Jonathan |date=September 27, 2017 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=February 1, 2018 |archive-url=https://web.archive.org/web/20180130231157/https://www.cdc.gov/hiv/library/dcl/dcl/092717.html |archive-date=January 30, 2018 |url-status=live }}</ref><ref name="Risk of sexual transmission of huma">{{cite journal |last1=LeMessurier |first1=J |last2=Traversy |first2=G |last3=Varsaneux |first3=O |last4=Weekes |first4=M |last5=Avey |first5=MT |last6=Niragira |first6=O |last7=Gervais |first7=R |last8=Guyatt |first8=G |last9=Rodin |first9=R |date=November 19, 2018 |title=Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review |journal=[[Canadian Medical Association Journal]] |volume=190 |issue=46 |pages=E1350–E1360 |doi=10.1503/cmaj.180311 |pmid=30455270 |pmc=6239917}}</ref> Campaigns by [[Joint United Nations Programme on HIV/AIDS|UNAIDS]] and organizations around the world have communicated this as [[Undetectable = Untransmittable]].<ref>{{cite web |title=Undetectable = untransmittable |url=https://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable |access-date=August 26, 2022 |website=[[UNAIDS]] |archive-date=December 11, 2023 |archive-url=https://web.archive.org/web/20231211064449/https://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable |url-status=live }}</ref> Without treatment the infection can interfere with the [[immune system]], and eventually [[#Signs and symptoms|progress to AIDS]], sometimes taking many years. Following initial infection an individual may not notice any symptoms, or may experience a brief period of [[influenza-like illness]].<ref name="WHO2015Fact" /> During this period the person may not know that they are HIV-positive, yet they will be able to [[#Sexual|pass on the virus]]. Typically, this period is followed by a prolonged incubation period with no symptoms.<ref name="CDC21015Bas">{{cite web |title=About HIV/AIDS |url=https://www.cdc.gov/hiv/basics/whatishiv.html |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=February 11, 2016 |date=December 6, 2015 |archive-url=https://web.archive.org/web/20160224101946/http://www.cdc.gov/hiv/basics/whatishiv.html |archive-date=February 24, 2016 |url-status=dead }}</ref> Eventually the HIV infection increases the risk of developing other infections such as [[tuberculosis]], as well as other [[opportunistic infection]]s, and [[tumors]] which are rare in people who have normal immune function.<ref name="WHO2015Fact" /> The late stage is often also associated with [[Cachexia|unintended weight loss]].<ref name="CDC21015Bas" /> Without treatment a person living with HIV can expect to live for 11 years.<ref name="UNAIDS2007">{{cite web |author1=UNAIDS |author2=World Health Organization |date=December 2007 |title=2007 AIDS epidemic update |url=http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf |url-status=dead |archive-url=https://web.archive.org/web/20080527201701/http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf |archive-date=May 27, 2008 |access-date=March 12, 2008}}</ref> Early [[HIV testing|testing]] can show if treatment is needed to stop this progression and to prevent infecting others.

<!--Transmission and prevention -->
HIV is [[#Transmission|spread]] primarily by [[unprotected sex]] (including [[anal sex|anal]], [[Oral sex|oral]] and [[vaginal sex]]), contaminated [[hypodermic needle]]s or [[blood transfusion]]s, and [[Vertically transmitted infection|from mother to child]] during [[HIV and pregnancy|pregnancy]], delivery, or breastfeeding.<ref name="TransmissionM2007">{{cite book |veditors=Rom WN, Markowitz SB |title=Environmental and occupational medicine |year=2007 |publisher=[[Wolters Kluwer]]/Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-6299-1 |page=745 |url=https://books.google.com/books?id=H4Sv9XY296oC&pg=PA745 |edition=4th  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150911155744/https://books.google.com/books?id=H4Sv9XY296oC&pg=PA745 |archive-date=September 11, 2015 |url-status=live }}</ref> Some bodily fluids, such as saliva, sweat, and tears, do not transmit the virus.<ref name="CDCtransmission">{{cite web |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |year=2003 |url=https://www.cdc.gov/HIV/pubs/facts/transmission.htm |title=HIV and Its Transmission |access-date=May 23, 2006 |archive-url=https://web.archive.org/web/20050204141148/http://www.cdc.gov/HIV/pubs/facts/transmission.htm |archive-date=February 4, 2005}}</ref> [[Oral sex]] has little risk of transmitting the virus.<ref>{{cite web|date=April 9, 2021|title=Preventing Sexual Transmission of HIV|url=https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-sexual-risk/preventing-sexual-transmission-of-hiv|access-date=February 1, 2022|website=HIV.gov|archive-date=February 1, 2022|archive-url=https://web.archive.org/web/20220201062101/https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-sexual-risk/preventing-sexual-transmission-of-hiv|url-status=live}}</ref> Ways to avoid catching HIV and [[Preventive healthcare|preventing the spread]] include [[safe sex]], treatment to prevent infection ("[[Pre-exposure prophylaxis|PrEP]]"), treatment to stop infection in someone who has been recently exposed ("[[post-exposure prophylaxis|PEP]]"),<ref name="WHO2015Fact" /> [[treatment as prevention|treating those who are infected]], and [[needle exchange program]]s. Disease in a baby can often be prevented by giving both the mother and child [[Management of HIV/AIDS|antiretroviral medication]].<ref name="WHO2015Fact">{{cite web |title=HIV/AIDS Fact sheet N°360 |url=https://www.who.int/mediacentre/factsheets/fs360/en/ |publisher=[[World Health Organization]] |access-date=February 11, 2016 |date=November 2015 |url-status=live |archive-url=https://web.archive.org/web/20160217160830/http://www.who.int/mediacentre/factsheets/fs360/en/ |archive-date=February 17, 2016 }}</ref>

<!-- Society and culture -->
Recognized worldwide in the early 1980s,<ref name=Gallo2/> HIV/AIDS has had a large impact on society, both as an illness and as a source of [[Discrimination against people with HIV/AIDS|discrimination]].<ref name="UNAIDS2006Ch4">{{cite book |title=2006 Report on the global AIDS epidemic |publisher=[[Joint United Nations Programme on HIV/AIDS|UNAIDS]] |year=2006 |isbn=978-92-9173-479-5 |chapter=The impact of AIDS on people and societies |chapter-url=http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH04_en.pdf |access-date=June 16, 2006 |archive-date=October 4, 2006 |archive-url=https://web.archive.org/web/20061004001821/http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH04_en.pdf |url-status=live }}</ref> The disease also has large [[Economic impact of HIV/AIDS|economic impacts]].<ref name="UNAIDS2006Ch4"/> There are many [[misconceptions about HIV/AIDS]], such as the belief that it can be transmitted by casual non-sexual contact.<ref>{{cite journal |last=Endersby |first=Jim |year=2016 |title=Myth Busters |url=http://austintexas.gov/page/myth-busters |url-status=dead |journal=[[Science (journal)|Science]] |volume=351 |issue=6268 |page=35 |bibcode=2016Sci...351...35E |doi=10.1126/science.aad2891 |archive-url=https://web.archive.org/web/20160222160217/http://austintexas.gov/page/myth-busters |archive-date=February 22, 2016 |access-date=February 14, 2016 |s2cid=51608938|url-access=subscription }}</ref> The disease has become subject to many [[Religion and HIV/AIDS|controversies involving religion]], including the [[Catholic Church and HIV/AIDS|Catholic Church's position]] not to support [[condom]] use as prevention.<ref>{{cite magazine |last=McCullom |first=Rob |date=February 26, 2013 |title=An African Pope Won't Change the Vatican's Views on Condoms and AIDS |url=https://www.theatlantic.com/sexes/archive/2013/02/an-african-pope-wont-change-the-vaticans-views-on-condoms-and-aids/273535/ |url-status=live |archive-url=https://web.archive.org/web/20160308135849/http://www.theatlantic.com/sexes/archive/2013/02/an-african-pope-wont-change-the-vaticans-views-on-condoms-and-aids/273535/ |archive-date=March 8, 2016 |access-date=February 14, 2016 |magazine=The Atlantic }}</ref> It has attracted international medical and political attention as well as large-scale funding since it was identified in the 1980s.<ref name="isbn1-59797-294-0">{{cite book |last=Harden |first=Victoria Angela |title=AIDS at 30: A History |publisher=Potomac Books Inc |year=2012 |isbn=978-1-59797-294-9 |page=324}}</ref>

<!--History and epidemiology -->
HIV made the jump from other primates to humans in west-central Africa in the early-to-mid-20th century.<ref name="Orgin2011">{{cite journal |vauthors=Sharp PM, Hahn BH |date=September 2011 |title=Origins of HIV and the AIDS pandemic |journal=Cold Spring Harbor Perspectives in Medicine |volume=1 |issue=1 |page=a006841 |doi=10.1101/cshperspect.a006841 |pmc=3234451 |pmid=22229120}}</ref> AIDS was [[History of HIV/AIDS|first recognized]] by the U.S. [[Centers for Disease Control and Prevention]] (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.<ref name=Gallo2>{{cite journal |vauthors=Gallo RC |date=October 2006 |title=A reflection on HIV/AIDS research after 25 years |journal=[[Retrovirology (journal)|Retrovirology]] |volume=3 |issue=1 |page=72 |doi=10.1186/1742-4690-3-72 |pmc=1629027 |pmid=17054781 |doi-access=free }}</ref> Between the first time AIDS was readily identified through 2024, the disease is estimated to have caused at least 42.3 million deaths worldwide.<ref name="WHO2024Factsheet"/> In 2023, 630,000 people died from HIV-related causes, an estimated 1.3 million people acquired HIV and about 39.9 million people worldwide living with HIV, 65% of whom are in the [[World Health Organization]] (WHO) [[Africa]]n Region.<ref name="WHO2024Factsheet"/><ref name=UN2022>{{cite web |url=https://www.unaids.org/en/resources/fact-sheet |title=Global HIV & AIDS statistics — 2022 fact sheet |website=[[UNAIDS]] |access-date=July 20, 2023 |archive-date=December 4, 2019 |archive-url=https://web.archive.org/web/20191204021652/https://www.unaids.org/en/resources/fact-sheet |url-status=live }}</ref> HIV/AIDS is considered a [[pandemic#HIV/AIDS|pandemic]]—a disease outbreak which is present over a large area and is actively spreading.<ref name=Kallings>{{cite journal |vauthors=Kallings LO |title=The first postmodern pandemic: 25 years of HIV/AIDS |journal=Journal of Internal Medicine |volume=263 |issue=3 |pages=218–43 |date=March 2008 |pmid=18205765 |doi=10.1111/j.1365-2796.2007.01910.x|s2cid=205339589 |doi-access=free }}(subscription required)</ref> The United States' National Institutes of Health (NIH) and the [[Gates Foundation]] have pledged $200 million focused on developing a global cure for AIDS.<ref>{{cite web |date=October 23, 2019 |title=NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale |url=https://www.nih.gov/news-events/news-releases/nih-launches-new-collaboration-develop-gene-based-cures-sickle-cell-disease-hiv-global-scale |access-date=September 24, 2021 |website=National Institutes of Health (NIH) |archive-date=September 4, 2021 |archive-url=https://web.archive.org/web/20210904180604/https://www.nih.gov/news-events/news-releases/nih-launches-new-collaboration-develop-gene-based-cures-sickle-cell-disease-hiv-global-scale |url-status=live }}</ref> 

== Signs and symptoms ==
{{Main|Signs and symptoms of HIV/AIDS}}
There are three main stages of [[Human immunodeficiency virus|HIV]] infection: acute infection, clinical latency, and AIDS.<ref name=AIDS2010GOV>{{cite web |title=What Are HIV and AIDS? |url=https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids |website=HIV.gov |access-date=September 10, 2017 |date=May 15, 2017 |archive-url=https://web.archive.org/web/20190922044900/https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids |archive-date=September 22, 2019 |url-status=dead }}</ref><ref name=M121>Mandell, Bennett, and Dolan (2010). Chapter 121.</ref>

=== First main stage: acute infection ===
[[File:Symptoms of acute HIV infection.svg|thumb|upright=1.25|alt=A diagram of a human torso labeled with the most common symptoms of an acute HIV infection|Main symptoms of acute HIV infection]]
The initial period following infection with HIV is called acute HIV, primary HIV or acute retroviral syndrome.<ref name=M121/><ref name=WHOCase2007/> Many individuals develop an [[influenza-like illness]], [[Infectious mononucleosis|mononucleosis or glandular fever]] 2–4 weeks after exposure while others have no significant symptoms.<ref>{{cite book |title=Diseases and disorders |year=2008 |publisher=Marshall Cavendish |location=Tarrytown, NY |isbn=978-0-7614-7771-6 |page=25 |url=https://books.google.com/books?id=-HRJOElZch8C&pg=PA25  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150919012701/https://books.google.com/books?id=-HRJOElZch8C&pg=PA25 |archive-date=September 19, 2015 |url-status=live }}</ref><ref name=M118/> Symptoms occur in 40–90% of cases and most commonly include [[fever]], [[lymphadenopathy|large tender lymph nodes]], [[pharyngitis|throat inflammation]], a [[rash]], headache, tiredness, and/or sores of the mouth and genitals.<ref name=WHOCase2007/><ref name=M118/> The rash, which occurs in 20–50% of cases, presents itself on the trunk and is [[maculopapular]], classically.<ref name=Deut2010/> Some people also develop [[opportunistic infections]] at this stage.<ref name=WHOCase2007/> Gastrointestinal symptoms, such as vomiting or [[diarrhea]] may occur.<ref name=M118/> Neurological symptoms of [[peripheral neuropathy]] or [[Guillain–Barré syndrome]] also occur.<ref name=M118/> The duration of the symptoms varies, but is usually one or two weeks.<ref name=M118/>

These [[Signs and symptoms|symptoms]] are not often [[Medical diagnosis#Pattern recognition|recognized]] as signs of HIV infection.<!--<ref name=M118/> --> Family doctors or hospitals can misdiagnose cases as one of the many common [[infectious disease]]s with similar symptoms.<!--<ref name=M118/> --> Someone with an [[Fever of unknown origin|unexplained fever]] who may have been recently exposed to HIV should consider testing to find out if they have been infected.<ref name=M118>Mandell, Bennett, and Dolan (2010). Chapter 118.</ref>

=== Second main stage: clinical latency ===
The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV.<ref name=AIDS2010GOV/> Without treatment, this second stage of the [[Natural history of disease|natural history]] of HIV infection can last from about three years<ref>{{cite book |last=Evian |first=Clive |title=Primary HIV/AIDS care: a practical guide for primary health care personnel in a clinical and supportive setting |year=2006 |publisher=Jacana |location=Houghton [South Africa] |isbn=978-1-77009-198-6 |page=29 |url=https://books.google.com/books?id=WauaC7M0yGcC&pg=PA29 |edition=Updated 4th  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150911043536/https://books.google.com/books?id=WauaC7M0yGcC&pg=PA29 |archive-date=September 11, 2015 |url-status=live }}</ref> to over 20&nbsp;years<ref>{{cite book |last=Hicks |first=Charles B. |editor1-last=Reeders |editor1-first=Jacques W.A.J. |editor2-last=Goodman |editor2-first=Philip Charles |title=Radiology of AIDS |year=2001 |publisher=Springer |location=Berlin [u.a.] |isbn=978-3-540-66510-6 |page=19 |url=https://books.google.com/books?id=xmFBtyPGOQIC&pg=PA19  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20160509101646/https://books.google.com/books?id=xmFBtyPGOQIC&pg=PA19 |archive-date=May 9, 2016 |url-status=live }}</ref> (on average, about eight years).<ref>{{cite book |last=Elliott |first=Tom |title=Lecture Notes: Medical Microbiology and Infection |year=2012 |publisher=[[John Wiley & Sons]] |isbn=978-1-118-37226-5 |page=273 |url=https://books.google.com/books?id=M4q3AyDQIUYC&pg=PA273  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150919014154/https://books.google.com/books?id=M4q3AyDQIUYC&pg=PA273 |archive-date=September 19, 2015 |url-status=live }}</ref> While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains.<ref name=AIDS2010GOV/> Between 50% and 70% of people also develop [[persistent generalized lymphadenopathy]], characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.<ref name=M121/>

Although most [[HIV-1]] infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of [[CD4]]<SUP>+</SUP> T cells ([[T helper cell]]s) without [[Management of HIV/AIDS|antiretroviral therapy]] for more than five years.<ref name=M118/><ref name=LT2010/> These individuals are classified as "HIV controllers" or [[long-term nonprogressors]] (LTNP).<ref name=LT2010>{{cite journal |vauthors=Blankson JN |title=Control of HIV-1 replication in elite suppressors |journal=Discovery Medicine |volume=9 |issue=46 |pages=261–66 |date=March 2010 |pmid=20350494}}</ref> Another group consists of those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors".<!--<ref name=Walker2007/> --> They represent approximately 1 in 300 infected persons.<ref name=Walker2007>{{cite journal |vauthors=Walker BD |title=Elite control of HIV Infection: implications for vaccines and treatment |journal=Topics in HIV Medicine |volume=15 |issue=4 |pages=134–36 |date=August–September 2007 |pmid=17720999}}</ref>

=== Third main stage: AIDS ===
[[File:Symptoms of AIDS.svg|thumb|upright=1.25|alt=A diagram of a human torso labeled with the most common symptoms of AIDS|Main symptoms of AIDS]]

Acquired immunodeficiency syndrome (AIDS) is defined as an HIV infection with either a CD4<SUP>+</SUP> T cell count below 200 cells per μL or the occurrence of specific diseases associated with HIV infection.<ref name=M118/> In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years.<ref name=M118/> The most common initial conditions that alert to the presence of AIDS are [[pneumocystis pneumonia]] (40%), [[cachexia]] in the form of HIV wasting syndrome (20%), and [[esophageal candidiasis]].<ref name=M118/> Other common signs include recurrent [[respiratory tract infection]]s.<ref name=M118/>

<!--Opportunistic infections -->
[[Opportunistic infections]] may be caused by [[bacteria]], [[virus]]es, [[fungi]], and [[parasite]]s that are normally controlled by the immune system.<ref name=Holmes>{{cite journal |vauthors=Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA |title=Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa |journal=[[Clinical Infectious Diseases]] |volume=36 |issue=5 |pages=652–62 |date=March 2003 |pmid=12594648 |doi=10.1086/367655|doi-access=free }}</ref> Which infections occur depends partly on what organisms are common in the person's environment.<ref name=M118/> These infections may affect nearly every [[biological system|organ system]].<ref name=Complications2011>{{cite journal |vauthors=Chu C, Selwyn PA |title=Complications of HIV infection: a systems-based approach |journal=American Family Physician |volume=83 |issue=4 |pages=395–406 |date=February 2011 |pmid=21322514}}</ref>

<!--AIDS related cancers -->
People with AIDS have an increased risk of developing various viral-induced cancers, including [[Kaposi's sarcoma]], [[Burkitt's lymphoma]], [[primary central nervous system lymphoma]], and [[cervical cancer]].<ref name=Deut2010/> Kaposi's sarcoma is the most common cancer, occurring in 10% to 20% of people with HIV.<ref name=M169>Mandell, Bennett, and Dolan (2010). Chapter 169.</ref> The second-most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3% to 4%.<ref name=M169/> Both these cancers are associated with [[Kaposi's sarcoma-associated herpesvirus|human herpesvirus 8]] (HHV-8).<ref name=M169/> Cervical cancer occurs more frequently in those with AIDS because of its association with [[human papillomavirus]] (HPV).<ref name=M169/> [[Conjunctiva|Conjunctival cancer]] (of the layer that lines the inner part of eyelids and the white part of the eye) is also more common in those with HIV.<ref>{{cite journal |vauthors=Mittal R, Rath S, Vemuganti GK |title=Ocular surface squamous neoplasia – Review of etio-pathogenesis and an update on clinico-pathological diagnosis |journal=Saudi Journal of Ophthalmology |volume=27 |issue=3 |pages=177–86 |date=July 2013 |pmid=24227983 |pmc=3770226 |doi=10.1016/j.sjopt.2013.07.002}}</ref>

<!--Systemic symptoms -->
Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, [[Night sweats|sweats]] (particularly at night), swollen lymph nodes, chills, weakness, and [[cachexia|unintended weight loss]].<ref>{{cite web |title=AIDS |url=https://www.nlm.nih.gov/medlineplus/ency/article/000594.htm |website=MedlinePlus |access-date=June 14, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120618135541/http://www.nlm.nih.gov/medlineplus/ency/article/000594.htm |archive-date=June 18, 2012 }}</ref> Diarrhea is another common symptom, present in about 90% of people with AIDS.<ref>{{cite journal |vauthors=Sestak K |title=Chronic diarrhea and AIDS: insights into studies with non-human primates |journal=Current HIV Research |volume=3 |issue=3 |pages=199–205 |date=July 2005 |pmid=16022653 |doi=10.2174/1570162054368084}}</ref> They can also be affected by diverse psychiatric and neurological symptoms independent of opportunistic infections and cancers.<ref>{{cite book |title=Bradley's Neurology in Clinical Practice: Expert Consult – Online and Print, 6e (Bradley, Neurology in Clinical Practice e-dition 2v Set) |year=2012 |publisher=Elsevier/Saunders |location=Philadelphia |isbn=978-1-4377-0434-1 |vauthors=Murray ED, Buttner N, Price BH |volume=1 |edition=6th |page=101 |veditors=Bradley WG, Daroff RB, Fenichel GM, Jankovic J |chapter=Depression and Psychosis in Neurological Practice}}</ref>

== Transmission ==
{| class="wikitable" style="float:right; clear:right; font-size:85%; margin-left:15px;"
|- style="background:#efefef; "
|+ Average per act risk of getting HIV<br/>by exposure route to an infected source
|- style="background:#efefef; "
! style="width: 100px" abbr="Route" | Exposure route
! style="width: 130px" abbr="Infections" | Chance of infection
|-
! style="text-align: left"| Blood transfusion
| 90%<ref name="Blood Transfusion Risk">{{cite journal |last1=Donegan |first1=Elizabeth |last2=Stuart |first2=Maria |last3=Niland |first3=Joyce C. |last4=Sacks |first4=Henry S. |last5=Azen |first5=Stanley P. |last6=Dietrich |first6=Shelby L. |last7=Faucett |first7=Cheryl |last8=Fletcher |first8=Mary Ann |last9=Kleinman |first9=Steven H. |last10=Operskalski |first10=Eva A. |last11=Perkins |first11=Herbert A. |last12=Pindyck |first12=Johanna |last13=Schiff |first13=Eugene R. |last14=Stites |first14=Daniel P. |last15=Tomasulo |first15=Peter A. |last16=Mosley |first16=James W. |title=Infection with Human Immunodeficiency Virus Type 1 (HIV-1) among Recipients of Antibody-Positive Blood Donations |journal=Annals of Internal Medicine |date=November 15, 1990 |volume=113 |issue=10 |pages=733–739 |doi=10.7326/0003-4819-113-10-733 |pmid=2240875 |url=https://annals.org/aim/article-abstract/704236/infection-human-immunodeficiency-virus-type-1-hiv-1-among-recipients?doi=10.7326%2f0003-4819-113-10-733 |access-date=May 11, 2020 |archive-date=June 3, 2018 |archive-url=https://web.archive.org/web/20180603040936/http://annals.org/aim/article-abstract/704236/infection-human-immunodeficiency-virus-type-1-hiv-1-among-recipients?doi=10.7326%2f0003-4819-113-10-733 |url-status=live |url-access=subscription }}</ref>
|-
! style="text-align: left"| Childbirth <small>(to child)</small>
| 25% without treatment;<br>1–2% with antiretroviral treatment<ref name=Coovadia>{{cite journal | author = Coovadia H | title = Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS | journal = N. Engl. J. Med. | volume = 351 | issue = 3 | pages = 289–292 | year = 2004 | pmid = 15247337 | doi = 10.1056/NEJMe048128 }}</ref>
|-
! style="text-align: left"| Needle-sharing injection drug use
| 0.67%<ref name=MMWR2005>{{cite journal |vauthors=Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE | title = Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. | journal = MMWR. Recommendations and Reports | volume = 54 | issue = RR-2 | pages = 1–20 | date = January 21, 2005 | pmid = 15660015 }}</ref>
|-
! style="text-align: left"| Percutaneous needle stick
| 0.30%<ref name=AFP2007>{{cite journal | author = Kripke C | title = Antiretroviral prophylaxis for occupational exposure to HIV. | journal = American Family Physician | volume = 76 | issue = 3 | pages = 375–6 | date = August 1, 2007 | pmid = 17708137 }}</ref>

|-
! style="text-align: left"| Receptive anal intercourse<sup>*</sup>
| 0.04–3.0%<ref name=Trans2010>{{cite journal |vauthors=Dosekun O, Fox J | title = An overview of the relative risks of different sexual behaviours on HIV transmission. | journal = Current Opinion in HIV and AIDS | volume = 5 | issue = 4 | pages = 291–7 | date = July 2010 | pmid = 20543603 | doi = 10.1097/COH.0b013e32833a88a3 }}</ref>

|-
! style="text-align: left"| Insertive anal intercourse<sup>*</sup>
| 0.03%<ref>{{cite book|last=Cunha|first=Burke|title=Antibiotic Essentials 2012|year=2012|publisher=Jones & Bartlett Publishers|isbn=9781449693831|pages=303|url=https://books.google.com/books?id=Xv-9TSdixgwC&pg=PA303|edition=11}}</ref>

|-
! style="text-align: left"| Receptive penile-vaginal intercourse<sup>*</sup>
| 0.05–0.30%<ref name=Trans2010/><ref name=LancetT2009>{{cite journal |vauthors=Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M | title = Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. | journal = The Lancet Infectious Diseases | volume = 9 | issue = 2 | pages = 118–29 | date = February 2009 | pmid = 19179227 | doi = 10.1016/S1473-3099(09)70021-0 | pmc=4467783}}</ref>

|-
! style="text-align: left"| Insertive penile-vaginal intercourse<sup>*</sup>
| 0.01–0.38%<ref name=Trans2010/><ref name=LancetT2009/>

|-
! style="text-align: left"| Receptive oral intercourse<sup>*§</sup>
| 0–0.04%<ref name=Trans2010/>

|-
! style="text-align: left"| Insertive oral intercourse<sup>*§</sup>
| 0–0.005%<ref>{{cite journal |vauthors=Baggaley RF, White RG, Boily MC | title = Systematic review of orogenital HIV-1 transmission probabilities. | journal = International Journal of Epidemiology | volume = 37 | issue = 6 | pages = 1255–65 | date = December 2008 | pmid = 18664564 | pmc = 2638872 | doi = 10.1093/ije/dyn151 }}</ref>

|- style="background:#efefef; "
! colspan=5 style="border-right:0;"| <sup>*</sup> assuming no condom use <br /> <sup>§</sup> source refers to oral intercourse<br/>performed on a man
|}

HIV is spread by three main routes: [[human sexual activity|sexual contact]], significant exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as [[vertical transmission]]).<ref name=TransmissionM2007/> There is no risk of acquiring HIV if exposed to [[feces]], nasal secretions, saliva, [[sputum]], sweat, tears, urine, or vomit unless these are contaminated with blood.<ref name=AFP2007k>{{cite journal |vauthors=Kripke C |title=Antiretroviral prophylaxis for occupational exposure to HIV |journal=American Family Physician |volume=76 |issue=3 |pages=375–76 |date=August 2007 |pmid=17708137}}</ref> It is also possible to be [[Coinfection|co-infected]] by more than one strain of HIV—a condition known as [[HIV superinfection]].<ref>{{cite journal |vauthors=van der Kuyl AC, Cornelissen M |title=Identifying HIV-1 dual infections |journal=Retrovirology |volume=4 |page=67 |date=September 2007 |pmid=17892568 |pmc=2045676 |doi=10.1186/1742-4690-4-67 |doi-access=free }}</ref>

=== Sexual ===
<!--Overview -->
The most frequent mode of transmission of HIV is through sexual contact with an infected person.<ref name=TransmissionM2007/> However, an HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually, known as [[Undetectable = Untransmittable]].<ref name="CDCUndetectable" /><ref name="Risk of sexual transmission of huma"/> The existence of functionally noncontagious HIV-positive people on antiretroviral therapy was controversially publicized in the 2008 [[Swiss Statement]], and has since become accepted as medically sound.<ref>{{cite journal |last1=Vernazza |first1=P |last2=Bernard |first2=EJ |title=HIV is not transmitted under fully suppressive therapy: The Swiss Statement – eight years later |journal=[[Swiss Medical Weekly]] |date=January 29, 2016 |volume=146 |pages=w14246 |doi=10.4414/smw.2016.14246|pmid=26824882 |doi-access=free }}</ref>

Globally, the most common mode of HIV transmission is via [[Heterosexuality|sexual contacts between people of the opposite sex]];<ref name=TransmissionM2007/> however, the pattern of transmission varies among countries. {{As of|2017}}, most HIV transmission in the United States occurred among [[men who had sex with men]] (82% of new HIV diagnoses among males aged 13 and older and 70% of total new diagnoses).<ref>{{cite web |title=HIV and Men |url=https://www.cdc.gov/hiv/group/gender/men/index.html |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=November 3, 2019 |archive-url=https://web.archive.org/web/20191201111721/https://www.cdc.gov/hiv/group/gender/men/index.html |archive-date=December 1, 2019 |url-status=dead }}</ref><ref>{{cite web |title=HIV and Gay and Bisexual Men |url=https://www.cdc.gov/hiv/group/msm/index.html |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=November 3, 2019 |archive-url=https://web.archive.org/web/20191102163544/https://www.cdc.gov/hiv/group/msm/index.html |archive-date=November 2, 2019 |url-status=dead }}</ref> In the US, gay and bisexual men aged 13 to 24 accounted for an estimated 92% of new HIV diagnoses among all men in their age group and 27% of new diagnoses among all gay and bisexual men.<ref name=CDC2016Bi>{{cite web |title=HIV Among Gay and Bisexual Men |url=https://www.cdc.gov/hiv/pdf/group/msm/cdc-hiv-msm.pdf |access-date=January 1, 2017 |url-status=dead |archive-url=https://web.archive.org/web/20161218225712/https://www.cdc.gov/hiv/pdf/group/msm/cdc-hiv-msm.pdf |archive-date=December 18, 2016 }}</ref>

<!--Per act risk -->
With regard to [[unprotected sex|unprotected]] heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries.<ref name=Boily2009/> In low-income countries, the risk of female-to-male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per act for male-to-female transmission.<ref name=Boily2009/> The risk of transmission from anal intercourse is especially high, estimated as 1.4–1.7% per act in both heterosexual and homosexual contacts.<ref name=Boily2009/><ref>{{cite journal |vauthors=Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, Brookmeyer R |title=Global epidemiology of HIV infection in men who have sex with men |journal=The Lancet |volume=380 |issue=9839 |pages=367–77 |date=July 2012 |pmid=22819660 |doi=10.1016/S0140-6736(12)60821-6 |pmc=3805037}}</ref> While the risk of transmission from [[oral sex]] is relatively low, it is still present.<ref>{{cite journal |vauthors=Yu M, Vajdy M |title=Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes |journal=[[Expert Opinion on Biological Therapy]] |volume=10 |issue=8 |pages=1181–95 |date=August 2010 |pmid=20624114 |pmc=2904634 |doi=10.1517/14712598.2010.496776}}</ref> The risk from receiving oral sex has been described as "nearly nil";<ref>{{cite book |last=Stürchler |first=Dieter A. |title=Exposure a guide to sources of infections |year=2006 |publisher=ASM Press |location=Washington, DC |isbn=978-1-55581-376-5 |page=544 |url=https://books.google.com/books?id=MWa5or3Xa9EC&pg=PA544  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20151130024240/https://books.google.com/books?id=MWa5or3Xa9EC&pg=PA544 |archive-date=November 30, 2015 |url-status=live }}</ref> however, a few cases have been reported.<ref>{{cite book |veditors=Pattman R, etal |title=Oxford handbook of genitourinary medicine, HIV, and sexual health |year=2010 |publisher=[[Oxford University Press]] |location=Oxford |isbn=978-0-19-957166-6 |page=95 |edition=2nd}}</ref> The per-act risk is estimated at 0–0.04% for receptive oral intercourse.<ref name=Dosekun2010>{{cite journal |vauthors=Dosekun O, Fox J |title=An overview of the relative risks of different sexual behaviours on HIV transmission |journal=[[Current Opinion in HIV and AIDS]] |volume=5 |issue=4 |pages=291–97 |date=July 2010 |pmid=20543603 |doi=10.1097/COH.0b013e32833a88a3|s2cid=25541753 }}</ref> In settings involving [[prostitution]] in low-income countries, risk of female-to-male transmission has been estimated as 2.4% per act, and of male-to-female transmission as 0.05% per act.<ref name=Boily2009>{{cite journal |vauthors=Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M |title=Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies |journal=The Lancet. Infectious Diseases |volume=9 |issue=2 |pages=118–29 |date=February 2009 |pmid=19179227 |pmc=4467783 |doi=10.1016/S1473-3099(09)70021-0}}</ref>

<!--Factors that increase the risk -->
Risk of transmission increases in the presence of many [[sexually transmitted infection]]s<ref name=CochraneSTI2012>{{cite journal |vauthors=Ng BE, Butler LM, Horvath T, Rutherford GW |title=Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |page=CD001220 |date=March 2011 |pmid=21412869 |doi=10.1002/14651858.CD001220.pub3 |editor1-last=Butler |editor1-first=Lisa M}}</ref> and [[genital ulcer]]s.<ref name=Boily2009/> Genital ulcers increase the risk approximately fivefold.<ref name=Boily2009/> Other sexually transmitted infections, such as [[gonorrhea]], [[Chlamydia infection|chlamydia]], [[trichomoniasis]], and [[bacterial vaginosis]], are associated with somewhat smaller increases in risk of transmission.<ref name=Dosekun2010/>

The [[viral load]] of an infected person is an important risk factor in both sexual and mother-to-child transmission.<ref>{{cite journal |vauthors=Anderson J |title=Women and HIV: motherhood and more |journal=Current Opinion in Infectious Diseases |volume=25 |issue=1 |pages=58–65 |date=February 2012 |pmid=22156896 |doi=10.1097/QCO.0b013e32834ef514|s2cid=6198083 }}</ref> During the first 2.5&nbsp;months of an HIV infection, a person's infectiousness is twelve times higher due to the high viral load associated with acute HIV.<ref name=Dosekun2010/> If the person is in the late stages of infection, rates of transmission are approximately eightfold greater.<ref name=Boily2009/>

Commercial sex workers (including [[Sexually transmitted infections in the pornography industry|those in pornography]]) have an increased likelihood of contracting HIV.<ref>{{cite book |url=https://books.google.com/books?id=f60h4OyZu_QC&pg=PA1 |title=The Global HIV Epidemics among Sex Workers |last=Kerrigan |first=Deanna |publisher=World Bank Publications |year=2012 |isbn=978-0-8213-9775-6 |pages=1–5  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150919020557/https://books.google.com/books?id=f60h4OyZu_QC&pg=PA1 |archive-date=September 19, 2015 |url-status=live }}</ref><ref>{{cite book |last=Aral |first=Sevgi |title=The New Public Health and STD/HIV Prevention: Personal, Public and Health Systems Approaches |year=2013 |publisher=Springer |isbn=978-1-4614-4526-5 |page=120 |url=https://books.google.com/books?id=eBbQ5QuqL9IC&pg=PA120  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150924071934/https://books.google.com/books?id=eBbQ5QuqL9IC&pg=PA120 |archive-date=September 24, 2015 |url-status=live }}</ref> Rough sex can be a factor associated with an increased risk of transmission.<ref>{{cite journal |vauthors=Klimas N, Koneru AO, Fletcher MA |title=Overview of HIV |journal=Psychosomatic Medicine |volume=70 |issue=5 |pages=523–30 |date=June 2008 |pmid=18541903 |doi=10.1097/PSY.0b013e31817ae69f|s2cid=38476611 }}</ref> [[Sexual assault]] is also believed to carry an increased risk of HIV transmission, as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections.<ref>{{cite journal |vauthors=Draughon JE, Sheridan DJ |title=Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: a review |journal=Psychology, Health & Medicine |volume=17 |issue=2 |pages=235–54 |year=2012 |pmid=22372741 |doi=10.1080/13548506.2011.579984|s2cid=205771853 }}</ref>

=== Body fluids ===
[[File:AIDS Poster If You're Dabbling in Drugs 1989.jpg|thumb|alt=A black-and-white poster of a young black man with a towel in his left hand with the words "If you are dabbling with drugs you could be dabbling with your life" above him|CDC poster from 1989 highlighting the threat of AIDS associated with drug use]]
The second-most frequent mode of HIV transmission is via blood and blood products.<ref name=TransmissionM2007/> Blood-borne transmission can be through needle-sharing during intravenous drug use, needle-stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment. <!--IVDU and needle stick -->The risk from sharing a needle during [[drug injection]] is between 0.63% and 2.4% per act, with an average of 0.8%.<ref name=Risk2006>{{cite journal |vauthors=Baggaley RF, Boily MC, White RG, Alary M |title=Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis |journal=AIDS |volume=20 |issue=6 |pages=805–12 |date=April 2006 |pmid=16549963 |doi=10.1097/01.aids.0000218543.46963.6d|s2cid=22674060 |doi-access=free }}</ref> The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the risk following [[mucous membrane]] exposure to infected blood as 0.09% (about 1 in 1000) per act.<ref name=AFP2007k/> This risk may, however, be up to 5% if the introduced blood was from a person with a high viral load and the cut was deep.<ref name=Needle2002>{{cite web |title=Needlestick Prevention Guide |url=https://www.who.int/occupational_health/activities/2needguid.pdf |access-date=November 10, 2019 |pages=5–6 |date=2002 |archive-url=https://web.archive.org/web/20180712204534/http://www.who.int/occupational_health/activities/2needguid.pdf |archive-date=July 12, 2018 |url-status=dead }}</ref> In the United States, intravenous drug users made up 12% of all new cases of HIV in 2009,<ref name=TransmissionCDC2012>{{cite web |title=HIV in the United States: An Overview |url=https://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/us_overview.htm |website=Center for Disease Control and Prevention |date=March 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130501102910/http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/us_overview.htm |archive-date=May 1, 2013 }}</ref> and in some areas more than 80% of people who inject drugs are HIV-positive.<ref name=TransmissionM2007/>

<!--Blood transfusion -->
HIV is transmitted in about 90% of [[blood transfusion]]s using infected blood.<ref name="Blood Transfusion Risk"/> In developed countries the risk of acquiring HIV from a blood transfusion is extremely low (less than one in half a million) where improved donor selection and [[HIV screening]] is performed;<ref name=TransmissionM2007/> for example, in the UK the risk was reported at one in five million in 2011<ref>{{cite web |title=Will I need a blood transfusion? |year=2011 |url=http://hospital.blood.co.uk/library/pdf/2011_Will_I_Need_English_v3.pdf |publisher=National Health Services |access-date=August 29, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20121025050828/http://hospital.blood.co.uk/library/pdf/2011_Will_I_Need_English_v3.pdf |archive-date=October 25, 2012 }}</ref> and in the United States it was one in 1.5&nbsp;million in 2008.<ref>{{cite journal |title=HIV transmission through transfusion – Missouri and Colorado, 2008 |journal=[[Morbidity and Mortality Weekly Report]] |volume=59 |issue=41 |pages=1335–39 |date=October 2010 |pmid=20966896 |author1=Centers for Disease Control Prevention (CDC)}}</ref> In low-income countries, only half of transfusions may be appropriately screened (as of 2008),<ref name=UN2011Seventy>UNAIDS 2011 pg. 60–70</ref> and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections.<ref name=TransmissionM2007/><ref name=WHO070401>{{cite web |publisher=World Health Organization |year=2001 |url=https://www.who.int/inf-pr-2000/en/pr2000-25.html |title=Blood safety&nbsp;... for too few |archive-date=January 17, 2005 |archive-url=https://web.archive.org/web/20050117092135/http://www.who.int/inf-pr-2000/en/pr2000-25.html}}</ref> It is possible to acquire HIV from organ and tissue [[Organ transplantation|transplantation]], although this is rare because of [[Diagnosis of HIV/AIDS|screening]].<ref>{{cite journal |vauthors=Simonds RJ |title=HIV transmission by organ and tissue transplantation |journal=[[AIDS (journal)|AIDS]] |volume=7 |pages=S35–38 |date=November 1993 |issue=Suppl 2 |pmid=8161444 |doi=10.1097/00002030-199311002-00008 |s2cid=28488664 |url=https://zenodo.org/record/1234768 |access-date=October 16, 2019 |archive-date=October 6, 2020 |archive-url=https://web.archive.org/web/20201006095732/https://zenodo.org/record/1234768/ |url-status=live }}</ref>

<!--Non-sanitary health practices - this is about medical injections in particular -->
Unsafe medical injections play a role in [[HIV/AIDS in Africa|HIV spread in sub-Saharan Africa]]. In 2007, between 12% and 17% of infections in this region were attributed to medical syringe use.<ref name=UnsafeInjection2009>{{cite journal |vauthors=Reid SR |title=Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review |journal=[[Harm Reduction Journal]] |volume=6 |page=24 |date=August 2009 |pmid=19715601 |pmc=2741434 |doi=10.1186/1477-7517-6-24 |doi-access=free }}</ref> The [[World Health Organization]] estimates the risk of transmission as a result of a medical injection in Africa at 1.2%.<ref name=UnsafeInjection2009/> Risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.<ref name=UnsafeInjection2009/>

People giving or receiving [[tattoo]]s, [[body piercing|piercings]], and [[scarification]] are theoretically at risk of infection but no confirmed cases have been documented.<ref name=CDCBasics2012>{{cite web |title=Basic Information about HIV and AIDS|url=https://www.cdc.gov/hiv/topics/basic/|website=Center for Disease Control and Prevention |date=April 2012 |url-status=dead |archive-url=https://web.archive.org/web/20170618025129/https://www.cdc.gov/hiv/topics/basic/ |archive-date=June 18, 2017 }}</ref> It is not possible for [[mosquito]]es or other insects to transmit HIV.<ref name="C4Wauto-8503951">{{cite web |url=http://www.rci.rutgers.edu/%7Einsects/aids.htm |title=Why Mosquitoes Cannot Transmit AIDS |website=[[Rutgers University]] |id=New Jersey Agricultural Experiment Station Publication No. H-40101-01-93 |date=June 1, 2010 |access-date=March 29, 2014 |first=Wayne J. |last=Crans |archive-url=https://web.archive.org/web/20140329183346/http://www.rci.rutgers.edu/~insects/aids.htm |archive-date=March 29, 2014}}</ref>

=== Mother-to-child ===
{{main|HIV and pregnancy|HIV and breastfeeding}}
HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk, resulting in the baby also contracting HIV.<ref name=TransmissionM2007/><ref>{{cite web |url=https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-mother-to-child-risk/preventing-mother-to-child-transmission-of-hiv |title=Preventing Mother-to-Child Transmission of HIV |website=HIV.gov |access-date=December 8, 2017 |archive-url=https://web.archive.org/web/20171209044313/https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-mother-to-child-risk/preventing-mother-to-child-transmission-of-hiv |archive-date=December 9, 2017 |url-status=live }}</ref> As of 2008, vertical transmission accounted for about 90% of cases of HIV in children.<ref name=Mother2010/> In the absence of treatment, the risk of transmission before or during birth is around 20%, and in those who also breastfeed 35%.<ref name=Mother2010/> Treatment decreases this risk to less than 5%.<ref>{{cite web |title=Mother-to-child transmission of HIV |url=https://www.who.int/hiv/topics/mtct/en/ |website=[[World Health Organization]] |access-date=December 27, 2019 |archive-url=https://web.archive.org/web/20191018093154/https://www.who.int/hiv/topics/mtct/en/ |archive-date=October 18, 2019 |url-status=dead }}</ref>

Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed.<ref>{{cite journal |vauthors=White AB, Mirjahangir JF, Horvath H, Anglemyer A, Read JS |title=Antiretroviral interventions for preventing breast milk transmission of HIV |journal=The Cochrane Database of Systematic Reviews |volume=2014 |issue=10 |page=CD011323 |date=October 2014 |pmid=25280769 |doi=10.1002/14651858.CD011323|pmc=10576873 }}</ref> If blood contaminates food during [[pre-chewing]] it may pose a risk of transmission.<ref name=CDCBasics2012/> If a woman is untreated, two years of breastfeeding results in an HIV/AIDS risk in her baby of about 17%.<ref name=WHO2011Breast>{{cite web |title=Infant feeding in the context of HIV |url=https://www.who.int/elena/titles/bbc/hiv_infant_feeding/en/ |website=[[World Health Organization]] |access-date=March 9, 2017 |date=April 2011 |url-status=dead |archive-url=https://web.archive.org/web/20170309062212/http://www.who.int/elena/titles/bbc/hiv_infant_feeding/en/ |archive-date=March 9, 2017 }}</ref> Due to the increased risk of death without breastfeeding in many areas in the developing world, the World Health Organization recommends either exclusive breastfeeding or the provision of safe formula.<ref name=WHO2011Breast/> All women known to be HIV-positive should be taking lifelong antiretroviral therapy.<ref name=WHO2011Breast/>

== Virology ==
{{Main|HIV}}
[[File:HI-virion-structure en.svg|thumb|alt=diagram of microscopic viron structure|Diagram of an HIV virion structure]]
[[File:HIV-budding-Color.jpg|thumb|alt=A large round blue object with a smaller red object attached to it. Multiple small green spots are speckled over both.|[[Scanning electron micrograph]] of HIV-1, colored green, budding from a cultured [[lymphocyte]]]]
[[HIV]] is the cause of the spectrum of disease known as HIV/AIDS. HIV is a [[retrovirus]] that primarily infects components of the human [[immune system]] such as CD4<SUP>+</SUP> T cells, [[macrophage]]s and [[dendritic cell]]s. It directly and indirectly destroys CD4<SUP>+</SUP> T cells.<ref name=Alimonti>{{cite journal | vauthors = Alimonti JB, Ball TB, Fowke KR | title = Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS | journal = The Journal of General Virology | volume = 84 | issue = Pt 7 | pages = 1649–61 | date = July 2003 | pmid = 12810858 | doi = 10.1099/vir.0.19110-0 | doi-access = free }}</ref>

HIV is a member of the [[genus]] ''[[Lentivirus]]'',<ref name=ICTV61.0.6>{{cite web | author=International Committee on Taxonomy of Viruses| author-link=International Committee on Taxonomy of Viruses | publisher=[[National Institutes of Health]] | year=2002 | url=https://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/61060000.htm |archive-url=https://web.archive.org/web/20060418135608/http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/61060000.htm | title=61.0.6. Lentivirus | newspaper=Men's Journal | access-date=June 25, 2012 |archive-date=April 18, 2006}}</ref> part of the family ''[[Retroviridae]]''.<ref name=ICTV61.>{{cite web | author=International Committee on Taxonomy of Viruses | publisher=National Institutes of Health | year=2002 | url=https://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/61000000.htm | title=61. Retroviridae | newspaper=Men's Journal | archive-url=https://web.archive.org/web/20011217155644/http://www.ncbi.nlm.nih.gov/ictvdb/ictvdb/61000000.htm | access-date=June 25, 2012 | archive-date=December 17, 2001 | url-status=live }}</ref> Lentiviruses share many [[morphology (biology)|morphological]] and [[biology|biological]] characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long [[incubation period]].<ref name=Levy>{{cite journal | vauthors = Levy JA | title = HIV pathogenesis and long-term survival | journal = AIDS | volume = 7 | issue = 11 | pages = 1401–10 | date = November 1993 | pmid = 8280406 | doi = 10.1097/00002030-199311000-00001 }}</ref> Lentiviruses are transmitted as single-stranded, positive-[[Sense (molecular biology)|sense]], enveloped [[RNA virus]]es. Upon entry into the target cell, the viral [[RNA]] [[genome]] is converted (reverse transcribed) into double-stranded [[DNA]] by a virally encoded [[reverse transcriptase]] that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded [[integrase]] and host co-factors.<ref name="JASmith">{{cite journal | vauthors = Smith JA, Daniel R | title = Following the path of the virus: the exploitation of host DNA repair mechanisms by retroviruses | journal = ACS Chemical Biology | volume = 1 | issue = 4 | pages = 217–26 | date = May 2006 | pmid = 17163676 | doi = 10.1021/cb600131q }}</ref> Once integrated, the virus may become [[Incubation period|latent]], allowing the virus and its host cell to avoid detection by the immune system.<ref>{{cite book|veditors=Martínez MA|title=RNA interference and viruses: current innovations and future trends|year=2010|publisher=Caister Academic Press|location=Norfolk|isbn=978-1-904455-56-1|page=73|url=https://books.google.com/books?id=C5TY8W74scIC&pg=PA73|access-date=June 27, 2015|archive-url=https://web.archive.org/web/20150911042839/https://books.google.com/books?id=C5TY8W74scIC&pg=PA73|archive-date=September 11, 2015|url-status=live}}</ref> Alternatively, the virus may be [[Transcription (genetics)|transcribed]], producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.<ref>{{cite book|editor=Gerald B. Pier|title=Immunology, infection, and immunity|year=2004|publisher=ASM Press|location=Washington, DC|isbn=978-1-55581-246-1|page=550|url=https://books.google.com/books?id=kBb-wYsMHEAC&pg=PA550|access-date=June 27, 2015|archive-url=https://web.archive.org/web/20160509095319/https://books.google.com/books?id=kBb-wYsMHEAC&pg=PA550|archive-date=May 9, 2016|url-status=live}}</ref>

HIV is now known to spread between CD4<SUP>+</SUP> T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it employs hybrid spreading mechanisms.<ref name=Zhang>{{cite journal | vauthors = Zhang C, Zhou S, Groppelli E, Pellegrino P, Williams I, Borrow P, Chain BM, Jolly C | title = Hybrid spreading mechanisms and T cell activation shape the dynamics of HIV-1 infection | journal = PLOS Computational Biology | volume = 11 | issue = 4 | page= e1004179 | date = April 2015 | pmid = 25837979 | pmc = 4383537 | doi = 10.1371/journal.pcbi.1004179 | arxiv = 1503.08992 | bibcode = 2015PLSCB..11E4179Z | doi-access = free }}</ref> In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter.<ref name="Zhang"/> HIV can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread.<ref name=Jolly>{{cite journal | vauthors = Jolly C, Kashefi K, Hollinshead M, Sattentau QJ | title = HIV-1 cell to cell transfer across an Env-induced, actin-dependent synapse | journal = [[The Journal of Experimental Medicine]] | volume = 199 | issue = 2 | pages = 283–93 | date = January 2004 | pmid = 14734528 | pmc = 2211771 | doi = 10.1084/jem.20030648 }}</ref><ref name=Sattentau>{{cite journal | vauthors = Sattentau Q | title = Avoiding the void: cell-to-cell spread of human viruses | journal = Nature Reviews. Microbiology | volume = 6 | issue = 11 | pages = 815–26 | date = November 2008 | pmid = 18923409 | doi = 10.1038/nrmicro1972 | s2cid = 20991705 | doi-access = free }}</ref> The hybrid spreading mechanisms of HIV contribute to the virus' ongoing replication against antiretroviral therapies.<ref name="Zhang"/><ref name=Sigal>{{cite journal | vauthors = Sigal A, Kim JT, Balazs AB, Dekel E, Mayo A, Milo R, Baltimore D | title = Cell-to-cell spread of HIV permits ongoing replication despite antiretroviral therapy | journal = [[Nature (journal)|Nature]] | volume = 477 | issue = 7362 | pages = 95–98 | date = August 2011 | pmid = 21849975 | doi = 10.1038/nature10347 | bibcode = 2011Natur.477...95S | s2cid = 4409389 | url = https://resolver.caltech.edu/CaltechAUTHORS:20110922-140553274 | archive-date = December 28, 2016 | access-date = March 1, 2025 | archive-url = https://web.archive.org/web/20161228132053/http://resolver.caltech.edu/CaltechAUTHORS:20110922-140553274/ | url-status = live }}</ref>

Two [[Subtypes of HIV|types of HIV]] have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more [[virulent]], more [[infectivity|infective]],<ref>{{cite journal | vauthors = Gilbert PB, McKeague IW, Eisen G, Mullins C, Guéye-NDiaye A, Mboup S, Kanki PJ | title = Comparison of HIV-1 and HIV-2 infectivity from a prospective cohort study in Senegal | journal = Statistics in Medicine | volume = 22 | issue = 4 | pages = 573–93 | date = February 2003 | pmid = 12590415 | doi = 10.1002/sim.1342 | s2cid = 28523977 }}</ref> and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to [[West Africa]].<ref name="Reeves">{{cite journal | vauthors = Reeves JD, Doms RW | title = Human immunodeficiency virus type 2 | journal = The Journal of General Virology | volume = 83 | issue = Pt 6 | pages = 1253–65 | date = June 2002 | pmid = 12029140 | doi = 10.1099/0022-1317-83-6-1253 | doi-access = free }}</ref>

== Pathophysiology ==
{{Main|Pathophysiology of HIV/AIDS}}
[[File:HIV and AIDS explained in a simple way.webm|thumb|upright=1.4|alt=video of AIDS explanation|HIV/AIDS explained in a simple way]]
[[File:Hiv replication cycle.gif|thumb|upright=1.4|HIV replication cycle]]

After the virus enters the body, there is a period of rapid [[viral replication]], leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood.<ref name=Piatak>{{cite journal | vauthors = Piatak M, Saag MS, Yang LC, Clark SJ, Kappes JC, Luk KC, Hahn BH, Shaw GM, Lifson JD | title = High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR | journal = Science | volume = 259 | issue = 5102 | pages = 1749–54 | date = March 1993 | pmid = 8096089 | doi = 10.1126/science.8096089 | bibcode = 1993Sci...259.1749P | s2cid = 12158927 }}</ref> This response is accompanied by a marked drop in the number of circulating [[T helper cell|CD4<sup>+</sup> T cells]]. The acute [[viremia]] is almost invariably associated with activation of [[cytotoxic T cell|CD8<sup>+</sup> T cells]], which kill HIV-infected cells, and subsequently with antibody production, or [[seroconversion]]. The CD8<sup>+</sup> T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4<sup>+</sup> T cell counts recover. A good CD8<sup>+</sup> T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.<ref name=Pantaleo1998>{{cite journal | vauthors = Pantaleo G, Demarest JF, Schacker T, Vaccarezza M, Cohen OJ, Daucher M, Graziosi C, Schnittman SS, Quinn TC, Shaw GM, Perrin L, Tambussi G, Lazzarin A, Sekaly RP, Soudeyns H, Corey L, Fauci AS | title = The qualitative nature of the primary immune response to HIV infection is a prognosticator of disease progression independent of the initial level of plasma viremia | journal = [[Proceedings of the National Academy of Sciences of the United States of America]] | volume = 94 | issue = 1 | pages = 254–58 | date = January 1997 | pmid = 8990195 | pmc = 19306 | doi = 10.1073/pnas.94.1.254 | bibcode = 1997PNAS...94..254P | doi-access = free }}</ref>

Ultimately, HIV causes AIDS by depleting CD4<sup>+</sup> T cells. This weakens the immune system and allows [[opportunistic infection]]s. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4<sup>+</sup> T cell depletion differs in the acute and chronic phases.<ref name="pmid16679064">{{cite journal |vauthors=Hel Z, McGhee JR, Mestecky J |title=HIV infection: first battle decides the war |journal=Trends in Immunology |volume=27 |issue=6 |pages=274–81 |date=June 2006 |pmid=16679064 |doi=10.1016/j.it.2006.04.007}}</ref> During the acute phase, HIV-induced cell lysis and killing of infected cells by CD8<sup>+</sup> T cells accounts for CD4<sup>+</sup> T cell depletion, although [[apoptosis]] may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4<sup>+</sup> T cell numbers.<ref>{{cite book |first1=Deenan |last1=Pillay |first2=Anna Maria |last2=Genetti |first3=Robin A. |last3=Weiss |editor-first=Arie J. |editor-last=Zuckerman |display-editors=etal |title=Principles and practice of clinical virology |year=2007 |publisher=Wiley |location=Hoboken, NJ |isbn=978-0-470-51799-4 |page=905 |chapter=Human Immunodeficiency Viruses |chapter-url=https://books.google.com/books?id=4il2mF7JG1sC&pg=PA905 |edition=6th}}</ref>

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4<sup>+</sup> T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.<ref name="pmid15365095">{{cite journal |vauthors=Mehandru S, Poles MA, Tenner-Racz K, Horowitz A, Hurley A, Hogan C, Boden D, Racz P, Markowitz M |title=Primary HIV-1 infection is associated with preferential depletion of CD4+ T lymphocytes from effector sites in the gastrointestinal tract |journal=The Journal of Experimental Medicine |volume=200 |issue=6 |pages=761–70 |date=September 2004 |pmid=15365095 |pmc=2211967 |doi=10.1084/jem.20041196}}</ref> The reason for the preferential loss of mucosal CD4<sup>+</sup> T cells is that the majority of mucosal CD4<sup>+</sup> T cells express the [[CCR5]] protein which HIV uses as a [[co-receptor]] to gain access to the cells, whereas only a small fraction of CD4<sup>+</sup> T cells in the bloodstream do so.<ref name="pmid15365096">{{cite journal |vauthors=Brenchley JM, Schacker TW, Ruff LE, Price DA, Taylor JH, Beilman GJ, Nguyen PL, Khoruts A, Larson M, Haase AT, Douek DC |title=CD4+ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract |journal=The Journal of Experimental Medicine |volume=200 |issue=6 | pages=749–59 |date=September 2004 |pmid=15365096 |pmc=2211962 |doi=10.1084/jem.20040874}}</ref> A [[CCR5-Δ32|specific genetic change]] that alters the CCR5 protein when present in both [[chromosome]]s very effectively prevents HIV-1 infection.<ref>{{cite journal |vauthors=Olson WC, Jacobson JM |title=CCR5 monoclonal antibodies for HIV-1 therapy |journal=Current Opinion in HIV and AIDS |volume=4 |issue=2 |pages=104–11 |date=March 2009 |pmid=19339948 |pmc=2760828 |doi=10.1097/COH.0b013e3283224015}}</ref>

HIV seeks out and destroys CCR5 expressing CD4<sup>+</sup> T cells during acute infection.<ref name=Julio2011>{{cite book |editor-last=Aliberti |editor-first=Julio |title=Control of Innate and Adaptive Immune Responses During Infectious Diseases |publisher=Springer Verlag |location=New York |isbn=978-1-4614-0483-5 |page=145 |url=https://books.google.com/books?id=TKMpo5aINVIC&pg=PA145 |year=2011  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150924083412/https://books.google.com/books?id=TKMpo5aINVIC&pg=PA145 |archive-date=September 24, 2015 |url-status=live }}</ref> A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4<sup>+</sup> T cells in mucosal tissues remain particularly affected.<ref name=Julio2011/> Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase.<ref name="pmid18161758">{{cite journal |vauthors=Appay V, Sauce D |title=Immune activation and inflammation in HIV-1 infection: causes and consequences |journal=The Journal of Pathology |volume=214 |issue=2 |pages=231–41 |date=January 2008 |pmid=18161758 |doi=10.1002/path.2276|s2cid=26830006 |doi-access=free }}</ref> Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory [[cytokine]]s, results from the activity of several HIV [[gene product]]s and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4<sup>+</sup> T cells during the acute phase of disease.<ref name="pmid17115046">{{cite journal |vauthors=Brenchley JM, Price DA, Schacker TW, Asher TE, Silvestri G, Rao S, Kazzaz Z, Bornstein E, Lambotte O, Altmann D, Blazar BR, Rodriguez B, Teixeira-Johnson L, Landay A, Martin JN, Hecht FM, Picker LJ, Lederman MM, Deeks SG, Douek DC |title=Microbial translocation is a cause of systemic immune activation in chronic HIV infection |journal=Nature Medicine |volume=12 |issue=12 |pages=1365–71 |date=December 2006 |pmid=17115046 |pmc=1717013 |doi=10.1038/nm1511}}</ref>

== Diagnosis ==
{{Main|Diagnosis of HIV/AIDS}}
[[File:Hiv-timecourse copy.svg|alt=A graph with two lines. One in blue moves from high on the right to low on the left with a brief rise in the middle. The second line in red moves from zero to very high then drops to low and gradually rises to high again|thumb|A generalized graph of the relationship between HIV copies (viral load) and CD4<SUP>+</SUP> T cell counts over the average course of untreated HIV infection: {{legend-line|blue solid 2px|CD4<sup>+</sup> T Lymphocyte count (cells/mm<sup>3</sup>)}} {{legend-line|red solid 2px|HIV RNA copies per mL of plasma}}]]
{| class="wikitable floatright"
|+Days after exposure needed for the test to be accurate<ref>{{cite web |url=https://www.cdc.gov/hiv/basics/testing.html |title=HIV/AIDS Testing |date=March 16, 2018 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=April 14, 2018 |archive-url=https://web.archive.org/web/20180414234419/https://www.cdc.gov/hiv/basics/testing.html |archive-date=April 14, 2018 |url-status=dead }}</ref>
!Blood test
!Days
|-
|Antibody test <small>(rapid test, [[ELISA]] 3rd gen)</small>
|23–90
|-
|Antibody and p24 antigen test <small>(ELISA 4th gen)</small>
|18–45
|-
|PCR
|10–33
|}
HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of [[AIDS defining clinical condition|certain signs or symptoms]].<ref name=WHOCase2007/> HIV screening is recommended by the [[United States Preventive Services Task Force]] for all people 15&nbsp;years to 65&nbsp;years of age, including all pregnant women.<ref name=USP2019Screen>{{cite journal |last1=US Preventive Services Task |first1=Force |last2=Owens |first2=DK |last3=Davidson |first3=KW |last4=Krist |first4=AH |last5=Barry |first5=MJ |last6=Cabana |first6=M |last7=Caughey |first7=AB |last8=Curry |first8=SJ |last9=Doubeni |first9=CA |last10=Epling JW |first10=Jr |last11=Kubik |first11=M |last12=Landefeld |first12=CS |last13=Mangione |first13=CM |last14=Pbert |first14=L |last15=Silverstein |first15=M |last16=Simon |first16=MA |last17=Tseng |first17=CW |last18=Wong |first18=JB |title=Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. |journal=JAMA |date=June 18, 2019 |volume=321 |issue=23 |pages=2326–2336 |doi=10.1001/jama.2019.6587 |pmid=31184701|doi-access=free }}</ref> Additionally, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness.<ref name=Deut2010/><ref name=USP2019Screen/> In many areas of the world, a third of HIV carriers only discover they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.<ref name=Deut2010/>

=== HIV testing ===
[[File:HIV Rapid Test being administered.jpg|thumb|HIV rapid test being administered]]
[[File:Oraquick.jpg|thumb|Oraquick HIV test]]
Most people infected with HIV develop [[seroconvert]]ed (antigen-specific) [[antibodies]] within three to twelve weeks after the initial infection.<ref name=M118/> Diagnosis of primary HIV before seroconversion is done by measuring HIV-[[RNA]] or [[Diagnosis of HIV/AIDS#Antigen tests|p24 antigen]].<ref name=M118/> Positive results obtained by antibody or [[Polymerase chain reaction|PCR]] testing are confirmed either by a different antibody or by PCR.<ref name=WHOCase2007/>

Antibody tests in children younger than 18&nbsp;months are typically inaccurate, due to the continued presence of [[Maternal Passive Immunity#Naturally acquired passive immunity|maternal antibodies]].<ref name=ChildDiag2010>{{cite journal |vauthors=Kellerman S, Essajee S |title=HIV testing for children in resource-limited settings: what are we waiting for? |journal=[[PLOS Medicine]] |volume=7 |issue=7 |page=e1000285 |date=July 2010 |pmid=20652012 |pmc=2907270 |doi=10.1371/journal.pmed.1000285 |doi-access=free }}</ref> Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen.<ref name=WHOCase2007/> Much of the world lacks access to reliable PCR testing, and people in many places simply wait until either symptoms develop or the child is old enough for accurate antibody testing.<ref name=ChildDiag2010/> In sub-Saharan Africa between 2007 and 2009, between 30% and 70% of the population were aware of their HIV status.<ref name=UN2011Eighty>UNAIDS 2011 pg. 70–80</ref> In 2009, between 3.6% and 42% of men and women in sub-Saharan countries were tested;<ref name=UN2011Eighty/> this represented a significant increase compared to previous years.<ref name=UN2011Eighty/>

===Classifications===
Two main clinical staging systems are used to classify HIV and HIV-related disease for [[Disease surveillance|surveillance]] purposes: the [[WHO disease staging system for HIV infection and disease]],<ref name=WHOCase2007/> and the [[CDC classification system for HIV infection]].<ref name=CDCCase2008/> The CDC's classification system is more frequently adopted in developed countries. Since the WHO's staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow a comparison for statistical purposes.<ref name=M121/><ref name=WHOCase2007/><ref name=CDCCase2008/>

The World Health Organization first proposed a definition for AIDS in 1986.<ref name=WHOCase2007/> Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007.<ref name=WHOCase2007>{{cite book |title=WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children |pages=6–16 |url=https://www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf |year=2007 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-159562-9 |url-status=live |archive-url=https://web.archive.org/web/20131031044253/http://www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf |archive-date=October 31, 2013 }}</ref> The WHO system uses the following categories:
* Primary HIV infection: May be either asymptomatic or associated with acute retroviral syndrome<ref name=WHOCase2007/>
* Stage I: HIV infection is [[asymptomatic]] with a CD4<SUP>+</SUP> T cell count (also known as CD4 count) greater than 500 per microlitre (μL or cubic mm) of blood.<ref name=WHOCase2007/> May include generalized lymph node enlargement.<ref name=WHOCase2007/>
* Stage II: Mild symptoms, which may include minor [[Mucous membrane|mucocutaneous]] manifestations and recurrent [[upper respiratory tract infection]]s. A CD4 count of less than 500/μL<ref name=WHOCase2007/>
* Stage III: Advanced symptoms, which may include unexplained [[Chronic (medical)|chronic]] diarrhea for longer than a month, severe bacterial infections including tuberculosis of the lung, and a CD4 count of less than 350/μL<ref name=WHOCase2007/>
* Stage IV or AIDS: severe symptoms, which include [[toxoplasmosis]] of the brain, [[candidiasis]] of the [[esophagus]], [[trachea]], [[bronchi]], or [[lung]]s, and [[Kaposi's sarcoma]]. A CD4 count of less than 200/μL<ref name=WHOCase2007/>

The U.S. Centers for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008 and 2014.<ref name=CDCCase2008>{{cite journal |vauthors=Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT |title=Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years – United States, 2008 |journal=MMWR. Recommendations and Reports |volume=57 |issue=RR-10 |pages=1–12 |date=December 2008 |pmid=19052530 |url=https://www.cdc.gov/mmwr/PDF/rr/rr5710.pdf |access-date=October 17, 2020 |archive-date=October 17, 2020 |archive-url=https://web.archive.org/web/20201017160943/https://www.cdc.gov/mmwr/PDF/rr/rr5710.pdf |url-status=live }}</ref><ref name=CDC2014Clas>{{cite journal |title=Revised surveillance case definition for HIV infection – United States, 2014 |journal=MMWR. Recommendations and Reports |volume=63 |issue=RR-03 |pages=1–10 |date=April 2014 |pmid=24717910 |author1=Centers for Disease Control Prevention (CDC) |url=https://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf |access-date=October 17, 2020 |archive-date=October 17, 2020 |archive-url=https://web.archive.org/web/20201017133412/https://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf |url-status=live }}</ref> This system classifies HIV infections based on CD4 count and clinical symptoms, and describes the infection in five groups.<ref name=CDC2014Clas/> In those greater than six years of age it is:<ref name=CDC2014Clas/>
* Stage 0: the time between a negative or indeterminate HIV test followed less than 180 days by a positive test
* Stage 1: CD4 count ≥ 500&nbsp;cells/μL and no AIDS-defining conditions
* Stage 2: CD4 count 200 to 500&nbsp;cells/μL and no AIDS-defining conditions
* Stage 3: CD4 count ≤ 200&nbsp;cells/μL or AIDS-defining conditions
* Unknown: if insufficient information is available to make any of the above classifications.

For surveillance purposes, the AIDS diagnosis still stands even if, after treatment, the CD4<SUP>+</SUP> T cell count rises to above 200 per μL of blood or other AIDS-defining illnesses are cured.<ref name="M121"/>

== Prevention ==
{{Main|Prevention of HIV/AIDS}}
[[File:AIDS Clinic, McLeod Ganj, 2010.jpg|thumb|alt=A run down a two-story building with several signs related to AIDS prevention|AIDS clinic, [[McLeod Ganj]], Himachal Pradesh, India, 2010]]

=== Sexual contact ===
<!--Condoms -->
[[File:FACING AIDS a condom and a pill at a time - I am FACING AIDS because people I -3 are infected. (5202985364).jpg|thumb|People wearing AIDS awareness signs. On the left: "Facing AIDS a condom and a pill at a time"; on the right: "I am Facing AIDS because people I ♥ are infected"]]
Consistent [[condom]] use reduces the risk of HIV transmission by approximately 80% over the long term.<ref>{{cite journal |vauthors=Crosby R, Bounse S |title=Condom effectiveness: where are we now? |journal=Sexual Health |volume=9 |issue=1 |pages=10–17 |date=March 2012 |pmid=22348628 |doi=10.1071/SH11036|doi-access=free }}</ref> When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year.<ref name=WHOCondoms>{{cite web |publisher=World Health Organization |date=August 2003 |url=http://www.wpro.who.int/mediacentre/factsheets/fs_200308_Condoms/en/index.html |title=Condom Facts and Figures |access-date=January 17, 2006 |url-status=dead |archive-url=https://web.archive.org/web/20121018145513/http://www.wpro.who.int/mediacentre/factsheets/fs_200308_Condoms/en/index.html |archive-date=October 18, 2012 }}</ref> There is some evidence to suggest that [[female condom]]s may provide an equivalent level of protection.<ref>{{cite journal |vauthors=Gallo MF, Kilbourne-Brook M, Coffey PS |title=A review of the effectiveness and acceptability of the female condom for dual protection |journal=Sexual Health |volume=9 |issue=1 |pages=18–26 |date=March 2012 |pmid=22348629 |doi=10.1071/SH11037 |url=https://zenodo.org/record/1236046 |access-date=September 4, 2020 |archive-date=October 28, 2021 |archive-url=https://web.archive.org/web/20211028225037/https://zenodo.org/record/1236046 |url-status=live }}</ref> Application of a vaginal gel containing [[tenofovir]] (a [[reverse transcriptase inhibitor]]) immediately before sex seems to reduce infection rates by approximately 40% among African women.<ref name=VagGel2012>{{cite journal |vauthors=Celum C, Baeten JM |title=Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence |journal=Current Opinion in Infectious Diseases |volume=25 |issue=1 |pages=51–57 |date=February 2012 |pmid=22156901 |pmc=3266126 |doi=10.1097/QCO.0b013e32834ef5ef}}</ref> By contrast, use of the [[spermicide]] [[nonoxynol-9]] may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.<ref>{{cite journal |vauthors=Baptista M, Ramalho-Santos J |title=Spermicides, microbicides and antiviral agents: recent advances in the development of novel multi-functional compounds |journal=Mini Reviews in Medicinal Chemistry |volume=9 |issue=13 |pages=1556–67 |date=November 2009 |pmid=20205637 |doi=10.2174/138955709790361548}}</ref>

<!--Circumcision -->
[[Circumcision]] in [[sub-Saharan Africa]] "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months".<ref>{{cite journal |vauthors=Siegfried N, Muller M, Deeks JJ, Volmink J |title=Male circumcision for prevention of heterosexual acquisition of HIV in men |journal=The Cochrane Database of Systematic Reviews |issue=2 |page=CD003362 |date=April 2009 |volume=2013 |pmid=19370585 |doi=10.1002/14651858.CD003362.pub2 |editor1-last=Siegfried |editor1-first=Nandi|pmc=11666075 }}</ref> Owing to these studies, both the World Health Organization and [[UNAIDS]] recommended male circumcision in 2007 as a method of preventing female-to-male HIV transmission in areas with high rates of HIV.<ref>{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organization |date=March 28, 2007 |url=https://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html |url-status=dead |archive-url=https://web.archive.org/web/20110703140439/http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html |archive-date=July 3, 2011 }}</ref> However, whether it protects against male-to-female transmission is disputed,<ref>{{cite journal |vauthors=Larke N |title=Male circumcision, HIV and sexually transmitted infections: a review |journal=British Journal of Nursing |volume=19 |issue=10 |pages=629–34 |date=May 27, 2010 |pmid=20622758 |pmc=3836228 |doi=10.12968/bjon.2010.19.10.48201}}</ref><ref name="pmid19849961">{{cite journal |vauthors=Eaton L, Kalichman SC |title=Behavioral aspects of male circumcision for the prevention of HIV infection |journal=Current HIV/AIDS Reports |volume=6 |issue=4 |pages=187–93 |date=November 2009 |pmid=19849961 |pmc=3557929 |doi=10.1007/s11904-009-0025-9}}(subscription required)</ref> and whether it is of benefit in [[developed countries]] and among [[men who have sex with men]] is undetermined.<ref>{{cite journal |vauthors=Kim HH, Li PS, Goldstein M |title=Male circumcision: Africa and beyond? |journal=Current Opinion in Urology |volume=20 |issue=6 |pages=515–19 |date=November 2010 |pmid=20844437 |doi=10.1097/MOU.0b013e32833f1b21|s2cid=2158164 }}</ref><ref>{{cite journal |vauthors=Templeton DJ, Millett GA, Grulich AE |title=Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men |journal=Current Opinion in Infectious Diseases |volume=23 |issue=1 |pages=45–52 |date=February 2010 |pmid=19935420 |doi=10.1097/QCO.0b013e328334e54d|s2cid=43878584 }}</ref><ref>{{cite journal |vauthors=Wiysonge CS, Kongnyuy EJ, Shey M, Muula AS, Navti OB, Akl EA, Lo YR |title=Male circumcision for prevention of homosexual acquisition of HIV in men |journal=The Cochrane Database of Systematic Reviews |issue=6 |page=CD007496 |date=June 2011 |pmid=21678366 |doi=10.1002/14651858.CD007496.pub2 |editor1-last=Wiysonge |editor1-first=Charles Shey}}</ref>

<!--Education -->
Programs encouraging [[Abstinence-only sex education|sexual abstinence]] do not appear to affect subsequent HIV risk.<ref>{{cite journal |vauthors=Underhill K, Operario D, Montgomery P |title=Abstinence-only programs for HIV infection prevention in high-income countries |journal=The Cochrane Database of Systematic Reviews |issue=4 |page=CD005421 |date=October 2007 |pmid=17943855 |doi=10.1002/14651858.CD005421.pub2 |url=http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005421/frame.html |editor1-last=Operario |archive-url=https://web.archive.org/web/20101125105707/http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005421/frame.html  |url-status=dead |editor1-first=Don |archive-date=November 25, 2010 |access-date=May 31, 2012 |url-access=subscription }}</ref> Evidence of any benefit from [[peer education]] is equally poor.<ref name="pmid22641791">{{cite journal |vauthors=Tolli MV |title=Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies |journal=[[Health Education Research]] |volume=27 |issue=5 |pages=904–13 |date=October 2012 |pmid=22641791 |doi=10.1093/her/cys055|doi-access=free }}</ref> Comprehensive [[Sex education|sexual education]] provided at school may decrease high-risk behavior.<ref>{{cite journal |vauthors=Ljubojević S, Lipozenčić J |title=Sexually transmitted infections and adolescence |journal=Acta Dermatovenerologica Croatica |volume=18 |issue=4 |pages=305–10 |year=2010 |pmid=21251451}}</ref><ref>{{cite book |url=http://unesdoc.unesco.org/images/0026/002607/260770e.pdf |title=International technical guidance on sexuality education: an evidence-informed approach |publisher=UNESCO |year=2018 |isbn=978-92-3-100259-5 |location=Paris |page=12 |access-date=February 22, 2018 |archive-url=https://web.archive.org/web/20181113072101/http://unesdoc.unesco.org/images/0026/002607/260770e.pdf |archive-date=November 13, 2018 |url-status=live }}</ref> A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV.<ref name="Patel2008">{{cite journal |vauthors=Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH |title=Discerning patterns of human immunodeficiency virus risk in healthy young adults |journal=[[The American Journal of Medicine]] |volume=121 |issue=9 |pages=758–64 |date=September 2008 |pmid=18724961 |pmc=2597652 |doi=10.1016/j.amjmed.2008.04.022}}</ref> Voluntary counseling and testing people for HIV does not affect risky behavior in those who test negative but does increase condom use in those who test positive.<ref>{{cite journal |vauthors=Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M |title=Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=9 |page=CD001224 |date=September 2012 |pmid=22972050 |pmc=3931252 |doi=10.1002/14651858.CD001224.pub4}}</ref> Enhanced family planning services appear to increase the likelihood of women with HIV using contraception, compared to basic services.<ref>{{cite journal |last1=Lopez |first1=LM |last2=Grey |first2=TW |last3=Chen |first3=M |last4=Denison |first4=J |last5=Stuart |first5=G |title=Behavioral interventions for improving contraceptive use among women living with HIV. |journal=The Cochrane Database of Systematic Reviews |date=August 9, 2016 |volume=2016 |issue=8 |pages=CD010243 |doi=10.1002/14651858.CD010243.pub3 |pmid=27505053|pmc=7092487 }}</ref> It is not known whether treating other sexually transmitted infections is effective in preventing HIV.<ref name=CochraneSTI2012/>

=== Pre-exposure ===
Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/μL is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP).<ref name=Anglemyer2013>{{cite journal |vauthors=Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N |title=Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=4 |page=CD009153 |date=April 2013 |pmid=23633367 |pmc=4026368 |doi=10.1002/14651858.CD009153.pub3}}</ref> TASP is associated with a 10- to 20-fold reduction in transmission risk.<ref name=Anglemyer2013/><ref name=Chou2012>{{cite journal |vauthors=Chou R, Selph S, Dana T, Bougatsos C, Zakher B, Blazina I, Korthuis PT |title=Screening for HIV: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation |journal=Annals of Internal Medicine |volume=157 |issue=10 |pages=706–18 |date=November 2012 |pmid=23165662 |doi=10.7326/0003-4819-157-10-201211200-00007|s2cid=27494096 }}</ref> [[Pre-exposure prophylaxis]] for HIV ("[[Pre-exposure prophylaxis for HIV prevention|PrEP]]") with a daily dose of the medications [[tenofovir]], with or without [[emtricitabine]], is effective in people at high risk including men who have sex with men, couples where one is HIV-positive, and young heterosexuals in Africa.<ref name=VagGel2012/><ref>{{cite journal |last1=Owens |first1=Douglas K. |last2=Davidson |first2=Karina W. |last3=Krist |first3=Alex H. |last4=Barry |first4=Michael J. |last5=Cabana |first5=Michael |last6=Caughey |first6=Aaron B. |last7=Curry |first7=Susan J. |last8=Doubeni |first8=Chyke A. |last9=Epling |first9=John W. |last10=Kubik |first10=Martha |last11=Landefeld |first11=C. Seth |last12=Mangione |first12=Carol M. |last13=Pbert |first13=Lori |last14=Silverstein |first14=Michael |last15=Simon |first15=Melissa A. |last16=Tseng |first16=Chien-Wen |last17=Wong |first17=John B. |title=Preexposure Prophylaxis for the Prevention of HIV Infection |journal=JAMA |date=June 11, 2019 |volume=321 |issue=22 |pages=2203–2213 |doi=10.1001/jama.2019.6390 |pmid=31184747|doi-access=free }}</ref> It may also be effective in intravenous drug users, with a study finding a decrease in risk of 0.7 to 0.4 per 100&nbsp;person&nbsp;years.<ref>{{cite journal |vauthors=Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, Chuachoowong R, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Hendrix CW, Vanichseni S |title=Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial |journal=The Lancet |volume=381 |issue=9883 |pages=2083–90 |date=June 2013 |pmid=23769234 |doi=10.1016/S0140-6736(13)61127-7|s2cid=5831642 }}</ref> The [[USPSTF]], in 2019, recommended PrEP in those who are at high risk.<ref>{{cite journal |last1=US Preventive Services Task |first1=Force |last2=Owens |first2=DK |last3=Davidson |first3=KW |last4=Krist |first4=AH |last5=Barry |first5=MJ |last6=Cabana |first6=M |last7=Caughey |first7=AB |last8=Curry |first8=SJ |last9=Doubeni |first9=CA |last10=Epling JW |first10=Jr |last11=Kubik |first11=M |last12=Landefeld |first12=CS |last13=Mangione |first13=CM |last14=Pbert |first14=L |last15=Silverstein |first15=M |last16=Simon |first16=MA |last17=Tseng |first17=CW |last18=Wong |first18=JB |title=Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. |journal=JAMA |date=June 11, 2019 |volume=321 |issue=22 |pages=2203–2213 |doi=10.1001/jama.2019.6390 |pmid=31184747|doi-access=free }}</ref>

[[Universal precautions]] within the health care environment are believed to be effective in decreasing the risk of HIV.<ref>{{cite journal |title=Recommendations for prevention of HIV transmission in health-care settings |journal=MMWR Supplements |volume=36 |issue=2 |pages=1S–18S |date=August 1987 |pmid=3112554 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm |archive-url=https://web.archive.org/web/20170709181703/https://www.cdc.gov/MMWR/PREVIEW/MMWRHTML/00023587.htm  |url-status=live |archive-date=July 9, 2017 |author1=Centers for Disease Control (CDC)}}</ref> [[Intravenous drug use]] is an important risk factor, and [[harm reduction]] strategies such as [[needle-exchange program]]s and [[Opioid replacement therapy|opioid substitution therapy]] appear effective in decreasing this risk.<ref name=Kurth2011>{{cite journal|author4-link=Sten H. Vermund |vauthors=Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN |title=Combination HIV prevention: significance, challenges, and opportunities |journal=Current HIV/AIDS Reports |volume=8 |issue=1 |pages=62–72 |date=March 2011 |pmid=20941553 |pmc=3036787 |doi=10.1007/s11904-010-0063-3}}</ref><ref>{{cite journal |vauthors=MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, Degenhardt L, Hickman M |title=Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis |journal=BMJ |volume=345 |issue=oct03 3 |page=e5945 |date=October 2012 |pmid=23038795 |pmc=3489107 |doi=10.1136/bmj.e5945}}</ref>

=== Post-exposure ===
A course of antiretrovirals administered within 48 to 72&nbsp;hours after exposure to HIV-positive blood or genital secretions is referred to as [[post-exposure prophylaxis]] (PEP).<ref name=Prevention2012/> The use of the single agent [[zidovudine]] reduces the risk of an HIV infection five-fold following a needle-stick injury.<ref name=Prevention2012>{{cite journal |title=HIV exposure through contact with body fluids |journal=Prescrire International |volume=21 |issue=126 |pages=100–01, 103–05 |date=April 2012 |pmid=22515138 }}</ref> {{As of|2013}}, the prevention regimen recommended in the United States consists of three medications—[[tenofovir]], [[emtricitabine]] and [[raltegravir]]—as this may reduce the risk further.<ref>{{cite journal |vauthors=Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL |title=Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis |journal=[[Infection Control and Hospital Epidemiology]] |volume=34 |issue=9 |pages=875–92 |date=September 2013 |pmid=23917901 |doi=10.1086/672271 |s2cid=17032413 |url=https://zenodo.org/record/1235708 |access-date=October 20, 2020 |archive-date=June 23, 2019 |archive-url=https://web.archive.org/web/20190623220711/https://zenodo.org/record/1235708 |url-status=live }}</ref>

PEP treatment is recommended after a [[sexual assault]] when the perpetrator is known to be HIV-positive, but is controversial when their HIV status is unknown.<ref name=NEJM2011Sex>{{cite journal |vauthors=Linden JA |title=Clinical practice. Care of the adult patient after sexual assault |journal=The New England Journal of Medicine |volume=365 |issue=9 |pages=834–41 |date=September 2011 |pmid=21879901 |doi=10.1056/NEJMcp1102869|s2cid=8388126 |doi-access=free }}</ref> The duration of treatment is usually four weeks<ref name=CochranePEP2007>{{cite journal |vauthors=Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford GW |title=Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure |journal=The Cochrane Database of Systematic Reviews |issue=1 |page=CD002835 |date=January 2007 |volume=2012 |pmid=17253483 |doi=10.1002/14651858.CD002835.pub3 |pmc=8989146 |editor1-last=Young |editor1-first=Taryn }}</ref> and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea (24%), fatigue (22%), emotional distress (13%) and headaches (9%).<ref name=AFP2007k/>

=== Mother-to-child ===
{{Main|HIV and pregnancy}}
Programs to prevent the [[vertical transmission]] of HIV (from mothers to children) can reduce rates of transmission by 92–99%.<ref name=Mother2010>{{cite journal |vauthors=Coutsoudis A, Kwaan L, Thomson M |title=Prevention of vertical transmission of HIV-1 in resource-limited settings |journal=Expert Review of Anti-Infective Therapy |volume=8 |issue=10 |pages=1163–75 |date=October 2010 |pmid=20954881 |doi=10.1586/eri.10.94|s2cid=46624541 }}</ref><ref name=Kurth2011/> This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant, and potentially includes [[bottle feeding]] rather than [[breastfeeding]].<ref name=Mother2010/><ref>{{cite journal |vauthors=Siegfried N, van der Merwe L, Brocklehurst P, Sint TT |title=Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection |journal=The Cochrane Database of Systematic Reviews |issue=7 |page=CD003510 |date=July 2011 |pmid=21735394 |doi=10.1002/14651858.CD003510.pub3 |editor1-last=Siegfried |editor1-first=Nandi}}</ref> If replacement feeding is acceptable, feasible, affordable, sustainable and safe, mothers should avoid breastfeeding their infants; however, exclusive breastfeeding is recommended during the first months of life if this is not the case.<ref>{{cite web |url=https://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf |access-date=March 12, 2008 |title=WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV – Infections in Pregnant Women, Mothers and their Infants – Consensus statement |date=October 25–27, 2006 |archive-url=https://web.archive.org/web/20080409065845/http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf |archive-date=April 9, 2008 |url-status=dead}}</ref> If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.<ref>{{cite journal |vauthors=Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS |title=Interventions for preventing late postnatal mother-to-child transmission of HIV |journal=The Cochrane Database of Systematic Reviews |issue=1 |pages=CD006734 |date=January 2009 |volume=2009 |pmid=19160297 |doi=10.1002/14651858.CD006734.pub2 |editor1-last=Horvath |editor1-first=Tara|pmc=7389566 }}</ref> In 2015, [[Cuba]] became the first country in the world to eradicate mother-to-child transmission of HIV.<ref>{{cite web |url=https://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/ |title=WHO validates elimination of mother-to-child transmission of HIV and syphilis in Cuba |publisher=World Health Organization |date=June 30, 2015 |access-date=August 30, 2015 |url-status=dead |archive-url=https://web.archive.org/web/20150904154356/http://who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/ |archive-date=September 4, 2015 }}</ref>

=== Vaccination ===
{{main|HIV vaccine development}}

Currently there is no licensed [[HIV vaccine development|vaccine for HIV or AIDS]].<ref name="UN2012Vac" /> The most effective vaccine trial to date, [[RV 144]], was published in 2009; it found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine.<ref>{{cite journal |vauthors=Reynell L, Trkola A |title=HIV vaccines: an attainable goal? |journal=[[Swiss Medical Weekly]] |volume=142 |page=w13535 |date=March 2012 |pmid=22389197 |doi=10.4414/smw.2012.13535|doi-access=free }}</ref>

== Treatment ==
{{Main|Management of HIV/AIDS}}
HIV/AIDS is a [[terminal illness]], as there is currently no cure, nor an effective HIV vaccine. Treatment consists of [[highly active antiretroviral therapy]] (ART), which slows progression of the disease.<ref name=LE2011>{{cite journal |vauthors=May MT, Ingle SM |title=Life expectancy of HIV-positive adults: a review |journal=Sexual Health |volume=8 |issue=4 |pages=526–33 |date=December 2011 |pmid=22127039 |doi=10.1071/SH11046}}</ref> As of 2022, 39 million people globally were living with HIV, and 29.8 million people were accessing ART.<ref name=":0">{{cite web |title=Global HIV & AIDS statistics — Fact sheet |url=https://www.unaids.org/en/resources/fact-sheet |access-date=December 1, 2023 |website=[[UNAIDS]] |archive-date=December 4, 2019 |archive-url=https://web.archive.org/web/20191204021652/https://www.unaids.org/en/resources/fact-sheet |url-status=live }}</ref> Treatment also includes preventive and active treatment of opportunistic infections. {{As of| July 2022}}, four people have been successfully cleared of HIV.<ref name="two">{{cite web |url=https://www.theguardian.com/science/2020/mar/09/second-person-cleared-hiv-adam-castillejo-reveals-identity |title=Second Person Ever to Be Cleared of HIV Reveals Identity |last=Davis |first=Nicola |date=March 8, 2020 |access-date=March 8, 2020 |work=[[The Guardian]] |archive-date=October 6, 2020 |archive-url=https://web.archive.org/web/20201006095735/https://www.theguardian.com/science/2020/mar/09/second-person-cleared-hiv-adam-castillejo-reveals-identity/ |url-status=live }}</ref><ref>{{cite web | url=https://www.theguardian.com/science/2022/feb/15/hiv-aids-cure-third-person-woman | title=Third person apparently cured of HIV using novel stem cell transplant | website=[[The Guardian]] | date=February 15, 2022 | access-date=August 1, 2022 | archive-date=April 30, 2023 | archive-url=https://web.archive.org/web/20230430183714/https://www.theguardian.com/science/2022/feb/15/hiv-aids-cure-third-person-woman | url-status=live }}</ref><ref>{{cite web | url=https://abcnews.go.com/Health/Wellness/man-cured-hiv-cancer-breakthrough-stem-cell-transplant/story?id=87505621 | title=Man cured of HIV, cancer following breakthrough stem cell transplant: Doctors | website=[[ABC News (United States)|ABC News]] | access-date=August 1, 2022 | archive-date=May 22, 2023 | archive-url=https://web.archive.org/web/20230522192632/https://abcnews.go.com/Health/Wellness/man-cured-hiv-cancer-breakthrough-stem-cell-transplant/story?id=87505621 | url-status=live }}</ref> Rapid initiation of antiretroviral therapy within one week of diagnosis appear to improve treatment outcomes in low and medium-income settings and is recommend for newly diagnosed HIV patients.<ref>{{cite journal |last1=Mateo-Urdiales |first1=Alberto |last2=Johnson |first2=Samuel |last3=Smith |first3=Rhodine |last4=Nachega |first4=Jean B |last5=Eshun-Wilson |first5=Ingrid |date=June 17, 2019 |editor-last=Cochrane Infectious Diseases Group |title=Rapid initiation of antiretroviral therapy for people living with HIV |journal=Cochrane Database of Systematic Reviews |volume=6 |issue=6 |pages=CD012962 |doi=10.1002/14651858.CD012962.pub2 |pmc=6575156 |pmid=31206168}}</ref><ref>{{cite web |title=Closing Gaps in HIV Care: Real-World Strategies to Support Rapid ART Initiation |url=https://primeinc.org/virtual/closing-gaps-hiv-care-real-world-strategies-support-rapid-art-initiation |access-date=June 3, 2023 |website=primeinc.org |archive-date=June 3, 2023 |archive-url=https://web.archive.org/web/20230603211249/https://primeinc.org/virtual/closing-gaps-hiv-care-real-world-strategies-support-rapid-art-initiation |url-status=live }}</ref>

=== Antiviral therapy ===
[[File:Stribild bottle Dutch labeling.jpg|thumb|alt=A white prescription bottle with the label Stribild. Next to it are ten green oblong pills with the marking 1 on one side and GSI on the other.|''[[Stribild]]'' – a common once-daily ART regime consisting of [[elvitegravir]], [[emtricitabine]], [[tenofovir]] and the booster [[cobicistat]]]]

<!--What it is -->
Current ART options are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes", of [[antiretroviral]] agents.<ref name=WHOTx2010Pg19>{{cite book |title=Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach |year=2010 |publisher=World Health Organization |isbn=978-92-4-159976-4 |pages=19–20 |url=http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf |url-status=dead |archive-url=https://web.archive.org/web/20120709184257/http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf |archive-date=July 9, 2012 }}</ref> There are eight classes of antiretroviral agents (ARVs), and over 30 individual drugs: nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase, inhibitors (NNRTIs), protease inhibitors (PIs), integrase strand transfer inhibitors (INSTIs), a fusion inhibitor, a CCR5 antagonist, a CD4 T lymphocyte (CD4) post-attachment inhibitor, and a gp120 attachment inhibitor. There are also two drugs, ritonavir (RTV) and cobicistat (COBI) which can be used as pharmacokinetic (PK) enhancers (or boosters) to improve the PK profiles of PIs and the INSTI elvitegravir (EVG).<ref name=":1">{{cite web |date=March 23, 2023 |title=HIV Clinical Guidelines: Adult and Adolescent ARV - What's New in the Guidelines |url=https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new |access-date=December 1, 2023 |website=clinicalinfo.hiv.gov |archive-date=November 26, 2023 |archive-url=https://web.archive.org/web/20231126215220/https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new |url-status=live }}</ref> Depending on the guidelines being followed, initial treatment generally consists of two nucleoside reverse transcriptase inhibitors along with a third ARV, either an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor with a pharmacokinetic enhancer (also known as a booster).<ref name=":1"/>

<!--When to start -->
The World Health Organization and the United States recommend antiretrovirals in people of all ages (including pregnant women) as soon as the diagnosis is made, regardless of CD4 count.<ref name=WHO2015Tx/><ref name="IAS2014">{{cite journal|vauthors=Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JS, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA|date=July 23–30, 2014|title=HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society–USA Panel|journal=JAMA|volume=312|issue=4|pages=390–409|doi=10.1001/jama.2014.7999|pmc=6309682|pmid=25038358}}</ref><ref name=DHHS2013>{{cite web |title=Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents |url=http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf |website=Department of Health and Human Services |access-date=January 3, 2014 |page=i |date=February 12, 2013 |url-status=dead |archive-url=https://web.archive.org/web/20161101202407/https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf |archive-date=November 1, 2016 }}</ref> Once treatment is begun, it is recommended that it is continued without breaks or "holidays".<ref name=Deut2010/> Many people are diagnosed only after treatment ideally should have begun.<ref name=Deut2010/> The desired outcome of treatment is a long-term plasma HIV-RNA count below 50&nbsp;copies/mL.<ref name=Deut2010>{{cite journal |vauthors=Vogel M, Schwarze-Zander C, Wasmuth JC, Spengler U, Sauerbruch T, Rockstroh JK |title=The treatment of patients with HIV |journal=Deutsches Ärzteblatt International |volume=107 |issue=28–29 |pages=507–15; quiz 516 |date=July 2010 |pmid=20703338 |pmc=2915483 |doi=10.3238/arztebl.2010.0507}}</ref> Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50&nbsp;copies/mL checks every three to six months are typically adequate.<ref name=Deut2010/> Inadequate control is deemed to be greater than 400&nbsp;copies/mL.<ref name=Deut2010/> Based on these criteria treatment is effective in more than 95% of people during the first year.<ref name=Deut2010/>

<!--Benefit -->
Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death.<ref>{{cite journal |vauthors=Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR |title=Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies |journal=The Lancet |volume=373 |issue=9672 |pages=1352–63 |date=April 2009 |pmid=19361855 |pmc=2670965 |doi=10.1016/S0140-6736(09)60612-7}}</ref> In the developing world, treatment also improves physical and mental health.<ref>{{cite journal |vauthors=Beard J, Feeley F, Rosen S |title=Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review |journal=[[AIDS Care]] |volume=21 |issue=11 |pages=1343–56 |date=November 2009 |pmid=20024710 |doi=10.1080/09540120902889926|s2cid=21883819 }}</ref> With treatment, there is a 70% reduced risk of acquiring tuberculosis.<ref name=WHOTx2010Pg19/> Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission.<ref name=WHOTx2010Pg19/><ref>{{cite journal |vauthors=Attia S, Egger M, Müller M, Zwahlen M, Low N |title=Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis |journal=AIDS |volume=23 |issue=11 |pages=1397–404 |date=July 2009 |pmid=19381076 |doi=10.1097/QAD.0b013e32832b7dca|s2cid=12221693 |doi-access=free }}</ref> The effectiveness of treatment depends to a large part on compliance.<ref name=Deut2010/> Reasons for non-adherence to treatment include poor access to medical care,<ref>{{cite journal |vauthors=Orrell C |title=Antiretroviral adherence in a resource-poor setting |journal=Current HIV/AIDS Reports |volume=2 |issue=4 |pages=171–76 |date=November 2005 |pmid=16343374 |doi=10.1007/s11904-005-0012-8|s2cid=44808279 }}</ref> inadequate social supports, [[mental illness]] and [[drug abuse]].<ref>{{cite journal |vauthors=Malta M, Strathdee SA, Magnanini MM, Bastos FI |title=Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review |journal=Addiction |volume=103 |issue=8 |pages=1242–57 |date=August 2008 |pmid=18855813 |doi=10.1111/j.1360-0443.2008.02269.x |url=https://www.arca.fiocruz.br/handle/icict/1377 |access-date=August 31, 2021 |archive-date=October 28, 2021 |archive-url=https://web.archive.org/web/20211028225006/https://www.arca.fiocruz.br/handle/icict/1377 |url-status=live }}</ref> The complexity of treatment regimens (due to pill numbers and dosing frequency) and [[adverse effect]]s may reduce adherence.<ref name="pmid21406048">{{cite journal |vauthors=Nachega JB, Marconi VC, van Zyl GU, Gardner EM, Preiser W, Hong SY, Mills EJ, Gross R |title=HIV treatment adherence, drug resistance, virologic failure: evolving concepts |journal=Infectious Disorders Drug Targets |volume=11 |issue=2 |pages=167–74 |date=April 2011 |pmid=21406048 |pmc=5072419 |doi=10.2174/187152611795589663}}</ref> Even though cost is an important issue with some medications,<ref>{{cite journal |vauthors=Orsi F, d'Almeida C |title=Soaring antiretroviral prices, TRIPS and TRIPS flexibilities: a burning issue for antiretroviral treatment scale-up in developing countries |journal=Current Opinion in HIV and AIDS |volume=5 |issue=3 |pages=237–41 |date=May 2010 |pmid=20539080 |doi=10.1097/COH.0b013e32833860ba|s2cid=205565246 }}</ref> 47% of those who needed them were taking them in low- and middle-income countries {{as of|2010|lc=y}},<ref name="UN2011Ten">UNAIDS 2011 pg. 1–10</ref> and the rate of adherence is similar in low-income and high-income countries.<ref>{{cite journal |vauthors=Nachega JB, Mills EJ, Schechter M |title=Antiretroviral therapy adherence and retention in care in middle-income and low-income countries: current status of knowledge and research priorities |journal=Current Opinion in HIV and AIDS |volume=5 |issue=1 |pages=70–77 |date=January 2010 |pmid=20046150 |doi=10.1097/COH.0b013e328333ad61|s2cid=7491569 }}</ref>

<!--Adverse effects -->
Specific adverse events are related to the antiretroviral agent taken.<ref name=Montessori2004/> Some relatively common adverse events include: [[HIV-associated lipodystrophy|lipodystrophy syndrome]], [[dyslipidemia]], and [[diabetes mellitus]], especially with protease inhibitors.<ref name=M121/> Other common symptoms include diarrhea,<ref name=Montessori2004>{{cite journal |vauthors=Montessori V, Press N, Harris M, Akagi L, Montaner JS |title=Adverse effects of antiretroviral therapy for HIV infection |journal=Canadian Medical Association Journal |volume=170 |issue=2 |pages=229–38 |date=January 2004 |pmid=14734438 |pmc=315530}}</ref><ref name="Burgoyne2008">{{cite journal |vauthors=Burgoyne RW, Tan DH |title=Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act |journal=[[Journal of Antimicrobial Chemotherapy]] |volume=61 |issue=3 |pages=469–73 |date=March 2008 |pmid=18174196 |doi=10.1093/jac/dkm499|doi-access=free }}</ref> and an increased risk of [[cardiovascular disease]].<ref>{{cite journal |vauthors=Barbaro G, Barbarini G |title=Human immunodeficiency virus & cardiovascular risk |journal=The Indian Journal of Medical Research |volume=134 |issue=6 |pages=898–903 |date=December 2011 |pmid=22310821 |pmc=3284097 |doi=10.4103/0971-5916.92634 |doi-access=free }}</ref> Newer recommended treatments are associated with fewer adverse effects.<ref name=Deut2010/> Certain medications may be associated with [[birth defect]]s and therefore may be unsuitable for women hoping to have children.<ref name=Deut2010/>

<!--In children -->
Treatment recommendations for children are somewhat different from those for adults. The World Health Organization recommends treating all children less than five years of age; children above five are treated like adults.<ref name=WHOCARV2013>{{cite web |title=Summary of recommendations on when to start ART in children |url=https://www.who.int/hiv/pub/guidelines/arv2013/art/WHO_CG_table_7.4.pdf?ua=1 |website=Consolidated ARV guidelines, June 2013 |format=PDF |date=June 2013 |url-status=dead |archive-url=https://web.archive.org/web/20141018175301/http://www.who.int/hiv/pub/guidelines/arv2013/art/WHO_CG_table_7.4.pdf?ua=1 |archive-date=October 18, 2014 }}</ref> The United States guidelines recommend treating all children less than 12 months of age and all those with HIV RNA counts greater than 100,000&nbsp;copies/mL between one year and five years of age.<ref name=DHHS2014>{{cite web |title=Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection |url=http://aidsinfo.nih.gov/contentfiles/lvguidelines/pedarv_recsonly.pdf |website=Department of Health and Human Services, February 2014 |date=March 2014 |url-status=dead |archive-url=https://web.archive.org/web/20150914053159/https://aidsinfo.nih.gov/contentfiles/lvguidelines/pedarv_recsonly.pdf |archive-date=September 14, 2015 }}</ref>

The [[European Medicines Agency]] (EMA) has recommended the granting of marketing authorizations for two new antiretroviral (ARV) medicines, [[rilpivirine]] (Rekambys) and [[cabotegravir]] (Vocabria), to be used together for the treatment of people with human immunodeficiency virus type 1 (HIV-1) infection.<ref name="EMA PR">{{cite press release | title=First long-acting injectable antiretroviral therapy for HIV recommended approval | website=[[European Medicines Agency]] (EMA) | date=October 16, 2020 | url=https://www.ema.europa.eu/en/news/first-long-acting-injectable-antiretroviral-therapy-hiv-recommended-approval | access-date=October 16, 2020 | archive-date=October 17, 2020 | archive-url=https://web.archive.org/web/20201017014521/https://www.ema.europa.eu/en/news/first-long-acting-injectable-antiretroviral-therapy-hiv-recommended-approval | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> The two medicines are the first ARVs that come in a long-acting injectable formulation.<ref name="EMA PR"/> This means that instead of daily pills, people receive intramuscular injections monthly or every two months.<ref name="EMA PR"/>

The combination of Rekambys and Vocabria injection is intended for maintenance treatment of adults who have undetectable HIV levels in the blood (viral load less than 50 copies/mL) with their current ARV treatment, and when the virus has not developed resistance to a certain class of anti-HIV medicines called non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase strand transfer inhibitors (INIs).<ref name="EMA PR"/>

[[Cabotegravir/rilpivirine|Cabotegravir combined with rilpivirine]] (Cabenuva) is a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults to replace a current antiretroviral regimen in those who are virologically suppressed on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either [[cabotegravir]] or [[rilpivirine]].<ref name="FDA PR">{{cite press release | title=FDA Approves First Extended-Release, Injectable Drug Regimen for Adults Living with HIV | website=U.S. [[Food and Drug Administration]] (FDA) | date=January 21, 2021 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-extended-release-injectable-drug-regimen-adults-living-hiv | access-date=January 21, 2021 | archive-date=January 21, 2021 | archive-url=https://web.archive.org/web/20210121213203/http://www.fda.gov/news-events/press-announcements/fda-approves-first-extended-release-injectable-drug-regimen-adults-living-hiv | url-status=dead }} {{PD-notice}}</ref><ref>{{cite news | title=F.D.A. Approves Monthly Shots to Treat H.I.V. | first=Apoorva | last=Mandavilli | website=[[The New York Times]] | date=January 21, 2021 | url=https://www.nytimes.com/2021/01/21/health/hiv-cabenuva.html |url-access=limited | access-date=January 22, 2021 | archive-date=January 22, 2021 | archive-url=https://web.archive.org/web/20210122000724/https://www.nytimes.com/2021/01/21/health/hiv-cabenuva.html | url-status=live }}</ref>

=== Opportunistic infections ===
{{main article|Opportunistic infection#Opportunistic Infection and HIV/AIDS}}
Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections.<ref name=Montessori2004/>

Adults and adolescents who are living with HIV (even on anti-retroviral therapy) with no evidence of active tuberculosis in settings with high tuberculosis burden should receive [[Isoniazid|isoniazid preventive therapy]] (IPT); the [[Mantoux test|tuberculin skin test]] can be used to help decide if IPT is needed.<ref name="WHOHIVTB2011">{{cite web |title=Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings |url=http://whqlibdoc.who.int/publications/2011/9789241500708_eng.pdf?ua=1 |website=Department of HIV/AIDS, World Health Organization 2011 |format=PDF |date=2011 |url-status=dead |archive-url=https://web.archive.org/web/20141019114659/http://whqlibdoc.who.int/publications/2011/9789241500708_eng.pdf?ua=1 |archive-date=October 19, 2014 }}</ref> Children with HIV may benefit from screening for tuberculosis.<ref>{{cite journal|last1=Vonasek|first1=Bryan|last2=Ness|first2=Tara|last3=Takwoingi|first3=Yemisi|last4=Kay|first4=Alexander W|last5=van Wyk|first5=Susanna S|last6=Ouellette|first6=Lara|last7=Marais|first7=Ben J|last8=Steingart|first8=Karen R|last9=Mandalakas|first9=Anna M|date=June 28, 2021|title=Screening tests for active pulmonary tuberculosis in children|journal=Cochrane Database of Systematic Reviews|volume=2021|issue=6|pages=CD013693|doi=10.1002/14651858.CD013693.pub2|issn=1465-1858|pmid=34180536|pmc=8237391}}</ref> [[Vaccination]] against [[hepatitis]] A and B is advised for all people at risk of HIV before they become infected; however, it may also be given after infection.<ref name="Laurence">{{cite journal |vauthors=Laurence J |title=Hepatitis A and B virus immunization in HIV-infected persons |journal=The AIDS Reader |volume=16 |issue=1 |pages=15–17 |date=January 2006 |pmid=16433468}}</ref>

[[Trimethoprim/sulfamethoxazole]] prophylaxis between four and six weeks of age, and ceasing breastfeeding of infants born to HIV-positive mothers, is recommended in resource-limited settings.<ref name="UN2011ONESIXTY">UNAIDS 2011 pg. 150–160</ref> It is also recommended to prevent PCP when a person's CD4 count is below 200&nbsp;cells/uL and in those who have or have previously had PCP.<ref name="PCP2011">{{cite journal |vauthors=Huang L, Cattamanchi A, Davis JL, den Boon S, Kovacs J, Meshnick S, Miller RF, Walzer PD, Worodria W, Masur H |title=HIV-associated Pneumocystis pneumonia |journal=Proceedings of the American Thoracic Society |volume=8 |issue=3 |pages=294–300 |date=June 2011 |pmid=21653531 |pmc=3132788 |doi=10.1513/pats.201009-062WR}}</ref> People with substantial immunosuppression are also advised to receive prophylactic therapy for [[toxoplasmosis]] and [[Mycobacterium avium-intracellulare infection|MAC]].<ref name="PEPpocketguide">{{cite web |publisher=[[United States Department of Health and Human Services|Department of Health and Human Services]] |date=February 2, 2007 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm |access-date=July 26, 2018 |title=Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America |archive-url=https://web.archive.org/web/20180727024527/https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm |archive-date=July 27, 2018 |url-status=live }}</ref> Appropriate preventive measures reduced the rate of these infections by 50% between 1992 and 1997.<ref name="InfectionBook2008"/> [[Influenza vaccination]] and [[pneumococcal polysaccharide vaccine]] are often recommended in people with HIV/AIDS with some evidence of benefit.<ref>{{cite journal |vauthors=Beck CR, McKenzie BC, Hashim AB, Harris RC, Zanuzdana A, Agboado G, etal |title=Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis |journal=Influenza and Other Respiratory Viruses |volume=7 |pages=72–75 |date=September 2013 |issue=Suppl 2 |pmid=24034488 |pmc=5909396 |doi=10.1111/irv.12084}}</ref><ref>{{cite journal |vauthors=Lee KY, Tsai MS, Kuo KC, Tsai JC, Sun HY, Cheng AC, Chang SY, Lee CH, Hung CC |title=Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy |journal=[[Human Vaccines & Immunotherapeutics]] |volume=10 |issue=12 |pages=3700–10 |date=2014 |pmid=25483681 |pmc=4514044 |doi=10.4161/hv.32247}}</ref>

=== Diet ===
{{Main|Nutrition and HIV/AIDS}}

The World Health Organization (WHO) has issued recommendations regarding nutrient requirements in HIV/AIDS.<ref name='WHO_nutrients'>{{cite book |last=World Health Organization |title=Nutrient requirements for people living with HIV/AIDS: Report of a technical consultation |date=May 2003 |publisher=World Health Organization |location=Geneva |url=https://www.who.int/nutrition/publications/Content_nutrient_requirements.pdf |access-date=March 31, 2009 |archive-url=https://web.archive.org/web/20090325030154/http://www.who.int/nutrition/publications/Content_nutrient_requirements.pdf |archive-date=March 25, 2009 |url-status=dead}}</ref> A generally healthy diet is promoted. Dietary intake of micronutrients at [[Reference Daily Intake|RDA]] levels by HIV-infected adults is recommended by the WHO; higher intake of [[vitamin A]], [[zinc]], and iron can produce adverse effects in HIV-positive adults, and is not recommended unless there is documented deficiency.<ref name="WHO_nutrients"/><ref>{{cite journal |vauthors=Forrester JE, Sztam KA |title=Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations? |journal=[[The American Journal of Clinical Nutrition]] |volume=94 |issue=6 |pages=1683S–1689S |date=December 2011 |pmid=22089440 |pmc=3226021 |doi=10.3945/ajcn.111.011999}}</ref><ref>{{cite journal |vauthors=Nunnari G, Coco C, Pinzone MR, Pavone P, Berretta M, Di Rosa M, Schnell M, Calabrese G, Cacopardo B |title=The role of micronutrients in the diet of HIV-1-infected individuals |journal=[[Frontiers in Bioscience]] |volume=4 |issue= 7|pages=2442–56 |date=June 2012 |pmid=22652651 |doi= 10.2741/e556|doi-access=free }}</ref><ref>{{cite journal |vauthors=Zeng L, Zhang L |title=Efficacy and safety of zinc supplementation for adults, children and pregnant women with HIV infection: systematic review |journal=Tropical Medicine & International Health |volume=16 |issue=12 |pages=1474–82 |date=December 2011 |pmid=21895892 |doi=10.1111/j.1365-3156.2011.02871.x|s2cid=6711255 |doi-access=free }}</ref> Dietary supplementation for people who are infected with HIV and who have inadequate nutrition or dietary deficiencies may strengthen their immune systems or help them recover from infections; however, evidence indicating an overall benefit in morbidity or reduction in mortality is not consistent.<ref>{{cite journal |vauthors=Visser ME, Durao S, Sinclair D, Irlam JH, Siegfried N |title=Micronutrient supplementation in adults with HIV infection |journal=The Cochrane Database of Systematic Reviews |volume=2017 |page=CD003650 |date=May 2017 |issue=5 |pmid=28518221 |pmc=5458097 |doi=10.1002/14651858.CD003650.pub4}}</ref>

People with HIV/AIDS are up to four times more likely to develop type 2 [[diabetes]] than those who are not tested positive with the virus.<ref>{{cite web |url=https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-diabetes#:~:text=People%20with%20HIV%20are%20more,and%20being%20overweight%20or%20obese |title=HIV and Diabetes |publisher=HIVInfo.NIH.gov |access-date=February 9, 2023 |archive-date=February 5, 2023 |archive-url=https://web.archive.org/web/20230205102829/https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-diabetes#:~:text=People%20with%20HIV%20are%20more,and%20being%20overweight%20or%20obese |url-status=live }}</ref>

Evidence for supplementation with [[selenium]] is mixed with some tentative evidence of benefit.<ref>{{cite journal | vauthors = Stone CA, Kawai K, Kupka R, Fawzi WW | title = Role of selenium in HIV infection | journal = Nutrition Reviews | volume = 68 | issue = 11 | pages = 671–81 | date = November 2010 | pmid = 20961297 | pmc = 3066516 | doi = 10.1111/j.1753-4887.2010.00337.x }}</ref> For pregnant and lactating women with HIV, [[multivitamin]] supplement improves outcomes for both mothers and children.<ref name=Siegfried2012>{{cite journal | vauthors = Siegfried N, Irlam JH, Visser ME, Rollins NN | title = Micronutrient supplementation in pregnant women with HIV infection | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD009755 | date = March 2012 | pmid = 22419344 | doi = 10.1002/14651858.CD009755 | pmc = 11747962 }}</ref> If the pregnant or lactating mother has been advised to take anti-retroviral medication to prevent mother-to-child HIV transmission, multivitamin supplements should not replace these treatments.<ref name=Siegfried2012/> There is some evidence that vitamin A supplementation in children with an HIV infection reduces mortality and improves growth.<ref>{{cite journal | vauthors = Irlam JH, Siegfried N, Visser ME, Rollins NC | title = Micronutrient supplementation for children with HIV infection | journal = The Cochrane Database of Systematic Reviews | issue = 10 | page= CD010666 | date = October 2013 | pmid = 24114375 | doi = 10.1002/14651858.CD010666 | pmc = 11747960 }}</ref>

===Alternative medicine===
In the US, approximately 60% of people with HIV use various forms of [[alternative medicine|complementary or alternative medicine]],<ref name="pmid18608078">{{cite journal | vauthors = Littlewood RA, Vanable PA | title = Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care | journal = AIDS Care | volume = 20 | issue = 8 | pages = 1002–18 | date = September 2008 | pmid = 18608078 | pmc = 2570227 | doi = 10.1080/09540120701767216 }}</ref> whose effectiveness has not been established.<ref name="pmid15969772">{{cite journal | vauthors = Mills E, Wu P, Ernst E | title = Complementary therapies for the treatment of HIV: in search of the evidence | journal = International Journal of STD & AIDS | volume = 16 | issue = 6 | pages = 395–403 | date = June 2005 | pmid = 15969772 | doi = 10.1258/0956462054093962 | s2cid = 7411052 }}</ref> There is not enough evidence to support the use of [[herbal medicine]]s.<ref>{{cite journal | vauthors = Liu JP, Manheimer E, Yang M | title = Herbal medicines for treating HIV infection and AIDS | journal = The Cochrane Database of Systematic Reviews | issue = 3 | page= CD003937 | date = July 2005 | volume = 2010 | pmid = 16034917 | doi = 10.1002/14651858.CD003937.pub2 | pmc = 8759069 | editor1-last = Liu | editor1-first = Jian Ping }}</ref> There is insufficient evidence to recommend or support the use of [[medical cannabis]] to try to increase appetite or weight gain.<ref name=lutge_2013>{{cite journal | vauthors = Lutge EE, Gray A, Siegfried N | title = The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | page= CD005175 | date = April 2013 | pmid = 23633327 | doi = 10.1002/14651858.CD005175.pub3 }}</ref>

== Prognosis ==
[[File:HIV-AIDS world map-Deaths per million persons-WHO2012.svg|upright=1.3|thumb|Deaths due to HIV/AIDS per million people in 2012: {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0}}{{legend|#ffe820|1–4}}{{legend|#ffd820|5–12}}{{legend|#ffc020|13–34}}{{legend|#ffa020|35–61}}{{legend|#ff9a20|62–134}}{{legend|#f08015|135–215}}{{legend|#e06815|216–458}}{{legend|#d85010|459–1,402}}{{legend|#d02010|1,403–5,828}}{{div col end}}]]
HIV/AIDS has become a [[Chronic (medicine)|chronic]] rather than an acutely fatal disease in many areas of the world.<ref name=Knoll2007/> Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes.<ref name=M118/> Without treatment, average survival time after infection with HIV is estimated to be 9 to 11&nbsp;years, depending on the HIV subtype.<ref name=UNAIDS2007/> After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19&nbsp;months.<ref name=Morgan2>{{cite journal | vauthors = Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA | title = HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries? | journal = AIDS | volume = 16 | issue = 4 | pages = 597–603 | date = March 2002 | pmid = 11873003 | doi = 10.1097/00002030-200203080-00011 | s2cid = 35450422 | doi-access = free }}</ref><ref>{{cite report|title=Progression and mortality of untreated HIV-positive individuals living in resource-limited settings: update of literature review and evidence synthesis |vauthors=Zwahlen M, Egger M |url=http://data.unaids.org/pub/Periodical/2006/zwahlen_unaids_hq_05_422204_2007_en.pdf |year=2006|access-date=March 19, 2008 |version=UNAIDS Obligation HQ/05/422204|archive-url=https://web.archive.org/web/20080409065844/http://data.unaids.org/pub/Periodical/2006/zwahlen_unaids_hq_05_422204_2007_en.pdf|archive-date=April 9, 2008|url-status=dead}}</ref> [[HAART|ART]] and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years.<ref name=Knoll2007>{{cite journal | vauthors = Knoll B, Lassmann B, Temesgen Z | title = Current status of HIV infection: a review for non-HIV-treating physicians | journal = International Journal of Dermatology | volume = 46 | issue = 12 | pages = 1219–28 | date = December 2007 | pmid = 18173512 | doi = 10.1111/j.1365-4632.2007.03520.x | s2cid = 26248996 }}</ref><ref name=LifeExpecr2008>{{cite journal |author=Antiretroviral Therapy Cohort Collaboration | title = Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies | journal = The Lancet | volume = 372 | issue = 9635 | pages = 293–99 | date = July 2008 | pmid = 18657708 | pmc = 3130543 | doi = 10.1016/S0140-6736(08)61113-7 }}</ref><ref name=Schack2006>{{cite journal | vauthors = Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, Weinstein MC, Seage GR, Moore RD, Freedberg KA | title = The lifetime cost of current human immunodeficiency virus care in the United States | journal = Medical Care | volume = 44 | issue = 11 | pages = 990–97 | date = November 2006 | pmid = 17063130 | doi = 10.1097/01.mlr.0000228021.89490.2a | s2cid = 21175266 }}</ref> This is between two thirds<ref name=LifeExpecr2008/> and nearly that of the general population.<ref name=Deut2010/><ref>{{cite journal | vauthors = van Sighem AI, Gras LA, Reiss P, Brinkman K, de Wolf F | title = Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals | journal = AIDS | volume = 24 | issue = 10 | pages = 1527–35 | date = June 2010 | pmid = 20467289 | doi = 10.1097/QAD.0b013e32833a3946 | s2cid = 205987336 | doi-access = free }}</ref> If treatment is started late in the infection, prognosis is not as good:<ref name=Deut2010/> for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40&nbsp;years.<ref name=Deut2010/><ref name=Knoll2007/> Half of infants born with HIV die before two years of age without treatment.<ref name=UN2011ONESIXTY/><ref>{{cite web |title=Early diagnosis and treatment save babies from AIDS-related death |url=https://www.unaids.org/en/resources/presscentre/featurestories/2009/may/20090527unicef |access-date=June 3, 2023 |website=[[UNAIDS]] |archive-date=June 3, 2023 |archive-url=https://web.archive.org/web/20230603211811/https://www.unaids.org/en/resources/presscentre/featurestories/2009/may/20090527unicef |url-status=live }}</ref>

[[File:HIV-AIDS world map - DALY - WHO2004.svg|thumb|left|upright=1.3|alt=A map of the world where much of it is colored yellow or orange except for sub Saharan Africa which is colored red or dark red|[[Disability-adjusted life year]] for HIV and AIDS per 100,000&nbsp;inhabitants as of 2004:
{{Col-begin}}
{{Col-break}}
{{legend|#b3b3b3|<small>no data</small>}}
{{legend|#ffff65|<small>≤&nbsp;10</small>}}
{{legend|#fff200|<small>10–25</small>}}
{{legend|#ffdc00|<small>25–50</small>}}
{{legend|#ffc600|<small>50–100</small>}}
{{Col-break}}
{{legend|#ffb000|<small>100–500</small>}}
{{legend|#ff9a00|<small>500–1000</small>}}
{{legend|#ff8400|<small>1,000–2,500</small>}}
{{legend|#ff6e00|<small>2,500–5,000</small>}}
{{legend|#ff5800|<small>5,000–7500</small>}}
{{Col-break}}
{{legend|#ff4200|<small>7,500–10,000</small>}}
{{legend|#ff2c00|<small>10,000–50,000</small>}}
{{legend|#cb0000|<small>≥&nbsp;50,000</small>}}
{{col-end}}]]
The primary causes of death from HIV/AIDS are [[opportunistic infections]] and [[cancer]], both of which are frequently the result of the progressive failure of the immune system.<ref name=InfectionBook2008>{{cite book|editor-last=Smith|editor-first=Blaine T.|title=Concepts in immunology and immunotherapeutics|year=2008|publisher=American Society of Health-System Pharmacists|location=Bethesda, MD|isbn=978-1-58528-127-5|page=143|url=https://books.google.com/books?id=G46DrdlxNJAC&pg=PA143|edition=4th|access-date=June 27, 2015|archive-url=https://web.archive.org/web/20151128082820/https://books.google.com/books?id=G46DrdlxNJAC&pg=PA143|archive-date=November 28, 2015|url-status=live}}</ref><ref name=Cancer2005>{{cite journal | vauthors = Cheung MC, Pantanowitz L, Dezube BJ | title = AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy | journal = The Oncologist | volume = 10 | issue = 6 | pages = 412–26 | date = Jun–Jul 2005 | pmid = 15967835 | doi = 10.1634/theoncologist.10-6-412 | citeseerx = 10.1.1.561.4760 | s2cid = 24329763 }}</ref> Risk of cancer appears to increase once the CD4 count is below 500/μL.<ref name=Deut2010/> The rate of clinical disease progression varies widely between individuals and has been shown to be affected by a number of factors such as a person's susceptibility and immune function;<ref name=Tang>{{cite journal | vauthors = Tang J, Kaslow RA | title = The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy | journal = AIDS | volume = 17 | issue = Suppl 4 | pages = S51–60 | year = 2003 | pmid = 15080180 | doi = 10.1097/00002030-200317004-00006 | doi-access = free }}</ref> their access to health care, the presence of co-infections;<ref name=Morgan2/><ref name=Lawn>{{cite journal | vauthors = Lawn SD | title = AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection | journal = The Journal of Infection | volume = 48 | issue = 1 | pages = 1–12 | date = January 2004 | pmid = 14667787 | doi = 10.1016/j.jinf.2003.09.001 }}</ref> and the particular strain (or strains) of the virus involved.<ref name=Campbell>{{cite journal | vauthors = Campbell GR, Pasquier E, Watkins J, Bourgarel-Rey V, Peyrot V, Esquieu D, Barbier P, de Mareuil J, Braguer D, Kaleebu P, Yirrell DL, Loret EP | title = The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis | journal = The Journal of Biological Chemistry | volume = 279 | issue = 46 | pages = 48197–204 | date = November 2004 | pmid = 15331610 | doi = 10.1074/jbc.M406195200 | doi-access = free | bibcode = 2004JBiCh.27948197C }}</ref><ref name=Campbell2>{{cite journal | vauthors = Campbell GR, Watkins JD, Esquieu D, Pasquier E, Loret EP, Spector SA | title = The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells | journal = The Journal of Biological Chemistry | volume = 280 | issue = 46 | pages = 38376–82 | date = November 2005 | pmid = 16155003 | doi = 10.1074/jbc.M506630200 | doi-access = free }}</ref>

[[Tuberculosis]] co-infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV-infected people and causing 25% of HIV-related deaths.<ref>{{cite web |title=Tuberculosis |url=https://www.who.int/mediacentre/factsheets/fs104/en/ |publisher=World Health Organization |date=March 2012 |access-date=August 29, 2012 |url-status=live |archive-url=https://web.archive.org/web/20120823143802/http://www.who.int/mediacentre/factsheets/fs104/en/ |archive-date=August 23, 2012 }}</ref> HIV is also one of the most important risk factors for tuberculosis.<ref name=WHO2011>{{cite book |title=Global tuberculosis control 2011 |author=World Health Organization |url=https://www.who.int/tb/publications/global_report/2011/gtbr11_executive_summary.pdf |year=2011 |publisher=World Health Organization |isbn=978-92-4-156438-0 |access-date=August 29, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120906223650/http://www.who.int/tb/publications/global_report/2011/gtbr11_executive_summary.pdf |archive-date=September 6, 2012 }}</ref> [[Hepatitis C]] is another very common co-infection where each disease increases the progression of the other.<ref>{{cite book |veditors=Rubin R, Strayer DS, Rubin E |title=Rubin's pathology: clinicopathologic foundations of medicine |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-1-60547-968-2 |page=154 |url=https://books.google.com/books?id=wb2TzY9AgJ0C&pg=PA154 |edition=Sixth |year=2011  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150924074740/https://books.google.com/books?id=wb2TzY9AgJ0C&pg=PA154 |archive-date=September 24, 2015 |url-status=live }}</ref> The two most common cancers associated with HIV/AIDS are [[Kaposi's sarcoma]] and AIDS-related [[non-Hodgkin's lymphoma]].<ref name=Cancer2005/> Other cancers that are more frequent include [[anal cancer]], [[Burkitt's lymphoma]], [[primary central nervous system lymphoma]], and [[cervical cancer]].<ref name=Deut2010/><ref>{{cite journal |vauthors=Nelson VM, Benson AB |title=Epidemiology of Anal Canal Cancer |journal=Surgical Oncology Clinics of North America |volume=26 |issue=1 |pages=9–15 |date=January 2017 |pmid=27889039 |doi=10.1016/j.soc.2016.07.001}}</ref>

Even with anti-retroviral treatment, over the long term HIV-infected people may experience [[AIDS dementia complex|neurocognitive disorders]],<ref name="Woods2009">{{cite journal |vauthors=Woods SP, Moore DJ, Weber E, Grant I |title=Cognitive neuropsychology of HIV-associated neurocognitive disorders |journal=[[Neuropsychology Review]] |volume=19 |issue=2 |pages=152–68 |date=June 2009 |pmid=19462243 |pmc=2690857 |doi= 10.1007/s11065-009-9102-5}}</ref><!-- Woods2009 covers neurocognitive --> [[osteoporosis]],<ref name="Brown2006">{{cite journal |vauthors=Brown TT, Qaqish RB |title=Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review |journal=AIDS |volume=20 |issue=17 |pages=2165–74 |date=November 2006 |pmid=17086056 |doi=10.1097/QAD.0b013e32801022eb|s2cid=19217950 |doi-access=free }}</ref><!-- Brown2006 covers osteoarthritis --> [[peripheral neuropathy|neuropathy]],<ref name="Nicholas2007">{{cite journal |vauthors=Nicholas PK, Kemppainen JK, Canaval GE, Corless IB, Sefcik EF, Nokes KM, Bain CA, Kirksey KM, Eller LS, Dole PJ, Hamilton MJ, Coleman CL, Holzemer WL, Reynolds NR, Portillo CJ, Bunch EH, Wantland DJ, Voss J, Phillips R, Tsai YF, Mendez MR, Lindgren TG, Davis SM, Gallagher DM |title=Symptom management and self-care for peripheral neuropathy in HIV/AIDS |journal=AIDS Care |volume=19 |issue=2 |pages=179–89 |date=February 2007 |pmid=17364396 |doi=10.1080/09540120600971083|s2cid=30220269 }}</ref><!-- Nicholas2007 covers neuropathy --> cancers,<ref name="Boshoff2002">{{cite journal |vauthors=Boshoff C, Weiss R |title=AIDS-related malignancies |journal=Nature Reviews. Cancer |volume=2 |issue=5 |pages=373–82 |date=May 2002 |pmid=12044013 |doi=10.1038/nrc797|s2cid=13513517 }}</ref><ref name="Yarchoan2005">{{cite journal |vauthors=Yarchoan R, Tosato G, Little RF |title=Therapy insight: AIDS-related malignancies – the influence of antiviral therapy on pathogenesis and management |journal=Nature Clinical Practice Oncology |volume=2 |issue=8 |pages=406–15; quiz 423 |date=August 2005 |pmid=16130937 |doi=10.1038/ncponc0253 |s2cid=23476060 |url=https://zenodo.org/record/1233371 |access-date=December 7, 2019 |archive-date=October 31, 2021 |archive-url=https://web.archive.org/web/20211031110334/https://zenodo.org/record/1233371 |url-status=live }}</ref><!-- Boshoff2002 and Yarchoan2005 cover cancer --> [[nephropathy]],<ref name="Post2009">{{cite journal |vauthors=Post FA, Holt SG |title=Recent developments in HIV and the kidney |journal =Current Opinion in Infectious Diseases |volume=22 |issue=1 |pages=43–48 |date=February 2009 |pmid=19106702 |doi=10.1097/QCO.0b013e328320ffec|s2cid=23085633 }}</ref><!-- Post2009 covers HIV/kidney --> and [[cardiovascular disease]].<ref name="Burgoyne2008"/><!-- Burgoyne2008 covers cardiovascular --> Some conditions, such as [[lipodystrophy]], may be caused both by HIV and its treatment.<ref name="Burgoyne2008"/>

== Epidemiology ==
{{Main|Epidemiology of HIV/AIDS}}
{{Image frame
|width=520<!-- Must be kept at this size at this point (December 2017) -->
|content ={{Global Heat Maps by Year| title=| table=HIV rates.tab| column=HIV_rate| columnName=Percent of people with HIV/AIDS| year=2017}}
|caption=Percentage of people with HIV/AIDS<ref name="auto">{{cite journal |last1=Roser |first1=Max |author1-link=Max Roser |last2=Ritchie |first2=Hannah |author2-link=Hannah Ritchie |title=HIV / AIDS |url=https://ourworldindata.org/hiv-aids |journal=Our World in Data |access-date=October 4, 2019 |date=April 3, 2018 |archive-url=https://web.archive.org/web/20191004044032/https://ourworldindata.org/hiv-aids |archive-date=October 4, 2019 |url-status=live }}</ref>
|align=right
}}
[[File:Deaths-and-new-cases-of-hiv.png|thumb|upright=1.8|Trends in new cases and deaths per year from HIV/AIDS, 1990-2017<ref name="auto"/>]]
HIV/AIDS is considered a global [[pandemic]].<ref name=Cohen2008>{{cite journal |vauthors=Cohen MS, Hellmann N, Levy JA, DeCock K, Lange J |title=The spread, treatment, and prevention of HIV-1: evolution of a global pandemic |journal=The Journal of Clinical Investigation |volume=118 |issue=4 |pages=1244–54 |date=April 2008 |pmid=18382737 |pmc=2276790 |doi=10.1172/JCI34706}}</ref> {{As of|2022}}, approximately 39.0&nbsp;million people worldwide are living with HIV, the number of new infections that year being about 1.3&nbsp;million.<ref name=":0"/> This is down from 2.1&nbsp;million new infections in 2010.<ref name=":0"/> Among new infections, 44% are in women and girls globally.<ref name=":0"/> There were 630,000 AIDS related deaths in 2022, down from a peak of 2&nbsp;million in 2005.<ref name=":0"/> The [[World Health Organization]] has reported that deaths from HIV and AIDS have "fallen by 61%, moving from the world’s seventh leading cause of death in 2000 to the twenty-first in 2021."<ref>{{Cite web |title=The top 10 causes of death |url=https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death |access-date=August 12, 2024 |website=www.who.int |language=en |url-status=live |archive-url=https://web.archive.org/web/20250221235623/https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death |archive-date=February 21, 2025}}</ref>

Among persons living with HIV (PLWH), the largest proportion reside in eastern and southern Africa (20.6 million, 54.6%). This region also had the highest rate of adult and child deaths due to AIDS in 2020 (310,000, 46.6%). Sub-Saharan African adolescent girls and young women (aged 15–24 years) account for 77% of new infections among this age-range globally.<ref name=":0"/> Here, in contrast to other regions, adolescent girls and young women are three times more likely to acquire HIV than age-matched males.<ref name=":0"/> Despite these statistics, overall, new HIV infections and AIDS-related deaths have substantially decreased in this region since 2010.<ref name=":2">{{cite web |last=Geneva: Joint United Nations Programme on HIV/AIDS |title=UNAIDS Data 2021 |url=https://www.unaids.org/sites/default/files/media_asset/JC3032_AIDS_Data_book_2021_En.pdf |access-date=December 1, 2023 |website=UNAIDS 2021 Reference |archive-date=December 7, 2023 |archive-url=https://web.archive.org/web/20231207155450/https://www.unaids.org/sites/default/files/media_asset/JC3032_AIDS_Data_book_2021_En.pdf |url-status=live }}</ref>

Eastern Europe and central Asia has observed a 43% increase in new HIV infections and 32% increase in AIDS-related deaths since 2010, the highest of all global regions.<ref name=":2"/> These infections are predominantly distributed in persons who inject drugs, with gay men and other men who have sex with men or persons who engage in transaction sex the second and third populations most impacted in this region.<ref name=":2"/>

At the end of 2019, United States indicated that approximately 1.2&nbsp;million people aged ≥13 years were living with HIV, resulting in about 18,500 deaths in 2020.<ref name=":3">{{cite web |date=August 10, 2022 |title=Statistics Overview |url=https://www.cdc.gov/hiv/statistics/overview/index.html |access-date=December 1, 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=December 7, 2018 |archive-url=https://web.archive.org/web/20181207084250/https://www.cdc.gov/hiv/statistics/overview/index.html |url-status=dead }}</ref> There were 34,800 estimated new infections in the US in 2019, 53% of which were in the southern region of the country.<ref name=":3"/> In addition to geographic location, significant disparities in HIV incidence exist among men, Black or Hispanic populations, and men who reported male-to-male sexual contact. The US Centers for Disease Control and Prevention estimated that in that year, 158,500 people or 13% of infected Americans were unaware of their infection.<ref name=":3"/>

In the [[HIV/AIDS in the United Kingdom|United Kingdom]] {{as of|2015|lc=y}}, there were approximately 101,200 cases which resulted in 594 deaths.<ref>{{cite book |url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf |title=HIV in the United Kingdom: 2016 Report |author=Public Health England |year=2016 |url-status=live |archive-url=https://web.archive.org/web/20170425115254/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf |archive-date=April 25, 2017 }}</ref> In Canada as of 2008, there were about 65,000 cases causing 53 deaths.<ref>{{cite book |title=HIV and AIDS in Canada: surveillance report to December 31, 2009 |year=2010 |publisher=Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Surveillance and Risk Assessment Division |location=Ottawa |isbn=978-1-100-52141-1 |url=http://www.phac-aspc.gc.ca/aids-sida/publication/survreport/2009/dec/pdf/2009-Report-Rapport.pdf |author=Risk Assessment Division |url-status=dead |archive-url=https://web.archive.org/web/20120119164919/http://www.phac-aspc.gc.ca/aids-sida/publication/survreport/2009/dec/pdf/2009-Report-Rapport.pdf |archive-date=January 19, 2012 }}</ref> Between the first recognition of AIDS (in 1981) and 2009, it has led to nearly 30&nbsp;million deaths.<ref name="TotalDeath2010">{{cite web |title=Global Report Fact Sheet |url=http://www.unaids.org/documents/20101123_FS_Global_em_en.pdf |website=UNAIDS |year=2010 |url-status=dead |archive-url=https://web.archive.org/web/20130916231221/http://www.unaids.org/documents/20101123_FS_Global_em_en.pdf |archive-date=September 16, 2013 }}</ref> Rates of HIV are lowest in North Africa and the Middle East (0.1% or less), [[East Asia]] (0.1%), and Western and Central Europe (0.2%).<ref name="UN2011Fifty">UNAIDS 2011 pp. 40–50</ref> The worst-affected European countries, in 2009 and 2012 estimates, are [[Russia]], [[Ukraine]], [[Latvia]], [[Moldova]], [[Portugal]] and [[Belarus]], in decreasing order of prevalence.<ref>{{cite web |title=Country Comparison:: HIV/AIDS – Adult Prevalence Rate |url=https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html |website=CIA World Factbook |access-date=November 6, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20141221190412/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html|archive-date=December 21, 2014 }}</ref>

Groups at higher risk of acquiring HIV include persons who engage in [[transactional sex]], [[gay men]] and other [[men who have sex with men]], [[Drug injection|persons who inject drugs]], [[Transgender|transgender persons]], and those who are [[Prison|incarcerated]] or [[Prison|detained]].<ref name=":0"/>

== History ==
{{Main|History of HIV/AIDS}}
{{For timeline}}
{{Further|Category:HIV/AIDS by country}}

=== Discovery ===
<!-- This section is the same as the equivalent section at HIV. (https://en.wikipedia.org/wiki/HIV)
Thus, if you update one please update the other as well -->
[[File:Mmwr-aids-July1981-report-101.png|thumb|right|alt=text of the Morbidity and Mortality Weekly Report newsletter|The ''[[Morbidity and Mortality Weekly Report]]'' reported in 1981 on what was later to be called "AIDS".]]<!-- note that this was not the first report, per CDC; see discussion [[Talk:HIV/AIDS#I've uploaded the original MMWR piece.. but...|here]] -->
The first news story on the disease appeared on May 18, 1981, in the gay newspaper ''[[New York Native]]''.<ref>{{cite news|title=On this day|work=[[News & Record]]|date=May 18, 2020|page=2A}}</ref><ref>{{cite web |last=Cloutier |first=Bill |title=Today in History, May 18 |url=https://www.rep-am.com/news/today_in_history/2020/05/17/today-in-history-may-18-2/ |website=Republican-American |access-date=May 19, 2020 |date=May 17, 2020 |archive-date=June 1, 2020 |archive-url=https://web.archive.org/web/20200601141613/https://www.rep-am.com/news/today_in_history/2020/05/17/today-in-history-may-18-2/ |url-status=dead }}</ref> AIDS was first clinically reported on June 5, 1981, with five cases in the United States.<ref name=M169/><ref>{{cite news |title=How I told the world about Aids |url=http://news.bbc.co.uk/2/hi/health/5041928.stm |access-date=February 12, 2019 |work=BBC News |date=June 5, 2006 |archive-url=https://web.archive.org/web/20190212190640/http://news.bbc.co.uk/2/hi/health/5041928.stm |archive-date=February 12, 2019 |url-status=live }}</ref> The initial cases were a cluster of injecting drug users and gay men with no known cause of impaired immunity who showed symptoms of ''[[Pneumocystis carinii]]'' pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems.<ref name=MMWR2>{{cite journal |vauthors=Gottlieb MS |title=Pneumocystis pneumonia – Los Angeles. 1981 |journal=[[American Journal of Public Health]] |volume=96 |issue=6 |pages=980–81; discussion 982–83 |date=June 2006 |pmid=16714472 |pmc=1470612 |doi=10.2105/AJPH.96.6.980 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm |archive-url=https://web.archive.org/web/20090422042240/http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm |url-status=live |archive-date=April 22, 2009}}</ref> Soon thereafter, a large number of homosexual men developed a generally rare skin cancer called [[Kaposi's sarcoma]] (KS).<ref name="pmid7287964">{{cite journal |vauthors=Friedman-Kien AE |title=Disseminated Kaposi's sarcoma syndrome in young homosexual men |journal=[[Journal of the American Academy of Dermatology]] |volume=5 |issue=4 |pages=468–71 |date=October 1981 |pmid=7287964 |doi=10.1016/S0190-9622(81)80010-2}}</ref><ref name="pmid6116083">{{cite journal |vauthors=Hymes KB, Cheung T, Greene JB, Prose NS, Marcus A, Ballard H, William DC, Laubenstein LJ |title=Kaposi's sarcoma in homosexual men-a report of eight cases |journal=The Lancet |volume=2 |issue=8247 |pages=598–600 |date=September 1981 |pmid=6116083 |doi=10.1016/S0140-6736(81)92740-9|s2cid=43529542 }}</ref> Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak.<ref name="Basavapathruni_2007">{{cite journal |vauthors=Basavapathruni A, Anderson KS |title=Reverse transcription of the HIV-1 pandemic |journal=FASEB Journal |volume=21 |issue=14 |pages=3795–808 |date=December 2007 |pmid=17639073 |doi=10.1096/fj.07-8697rev|doi-access=free |s2cid=24960391 }}</ref>

In the early days, the CDC did not have an official name for the disease, often referring to it by way of diseases associated with it, such as [[lymphadenopathy]], the disease after which the discoverers of HIV originally named the virus.<ref name=MMWR1982a>{{cite journal |author=Centers for Disease Control (CDC) |title=Persistent, generalized lymphadenopathy among homosexual males |journal=Morbidity and Mortality Weekly Report |volume=31 |issue=19 |pages=249–51 |date=May 1982 |pmid=6808340 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00001096.htm |archive-url=https://web.archive.org/web/20111018015418/http://cdc.gov/mmwr/preview/mmwrhtml/00001096.htm  |url-status=live |archive-date=October 18, 2011}}</ref><ref name="Montagnier">{{cite journal |vauthors=Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, Dauguet C, Axler-Blin C, Vézinet-Brun F, Rouzioux C, Rozenbaum W, Montagnier L |title=Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS) |journal=Science |volume=220 |issue=4599 |pages=868–71 |date=May 1983 |pmid=6189183 |doi=10.1126/science.6189183 |bibcode=1983Sci...220..868B|s2cid=390173 }}</ref> They also used ''Kaposi's sarcoma and opportunistic infections'', the name by which a task force had been set up in 1981.<ref name=MMWR1982b>{{cite journal |author=Centers for Disease Control (CDC) |title=Opportunistic infections and Kaposi's sarcoma among Haitians in the United States |journal=Morbidity and Mortality Weekly Report |volume=31 |issue=26 |pages=353–54, 360–61 |date=July 1982 |pmid=6811853 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00001123.htm |archive-url=https://web.archive.org/web/20110920181924/http://www.cdc.gov/mmwr/preview/mmwrhtml/00001123.htm  |url-status=live |archive-date=September 20, 2011}}</ref> At one point the CDC referred to it as the "4H disease", as the syndrome seemed to affect heroin users, homosexuals, [[hemophilia]]cs, and [[Haiti]]ans.<ref>{{cite journal |title=AIDS and Syphilis: The Iconography of Disease |journal=October |volume=43 |pages=87–107 |editor-last=Gilman |editor-first=Sander L. |year=1987 |jstor=3397566 |last=Gilman |first=Sander L. |doi=10.2307/3397566}}</ref><ref name=SciRep470b>{{cite web |publisher=[[American Association for the Advancement of Science]] |date=July 28, 2006 |url=http://www.scienceonline.org/cgi/reprint/313/5786/470b.pdf |title=Making Headway Under Hellacious Circumstances |access-date=June 23, 2008 |url-status=dead |archive-url=https://web.archive.org/web/20080624235131/http://www.scienceonline.org/cgi/reprint/313/5786/470b.pdf |archive-date=June 24, 2008 }}</ref> The term ''GRID'', which stood for [[gay-related immune deficiency]], had also been coined.<ref name=Altman>{{cite news |last=Altman |first=Lawrence K. |url=https://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html |title=New homosexual disorder worries health officials |work=[[The New York Times]] |date=May 11, 1982 |access-date=August 31, 2011 |url-status=live |archive-url=https://web.archive.org/web/20130430231803/http://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html |archive-date=April 30, 2013 }}</ref> However, after determining that AIDS was not isolated to the [[gay community]],<ref name=MMWR1982b/> it was realized that the term ''GRID'' was misleading, and the term ''AIDS'' was introduced at a meeting in July 1982.<ref name=Kher>{{cite magazine |last=Kher |first=Unmesh |title=A Name for the Plague |magazine=Time |date=July 27, 1982 |url=http://www.time.com/time/80days/820727.html |access-date=March 10, 2008 |archive-url=https://web.archive.org/web/20080307015307/http://www.time.com/time/80days/820727.html |archive-date=March 7, 2008 |url-status=dead}}</ref> By September 1982 the CDC started referring to the disease as AIDS.<ref name=MMWR1982c>{{cite journal |author=Centers for Disease Control (CDC) |title=Update on acquired immune deficiency syndrome (AIDS) – United States |journal=Morbidity and Mortality Weekly Report |volume=31 |issue=37 |pages=507–08, 513–14 |date=September 1982 |pmid=6815471}}</ref>

In 1983, two separate research groups led by [[Robert Gallo]] and [[Luc Montagnier]] declared that a novel retrovirus may have been infecting people with AIDS, and published their findings in the same issue of the journal ''[[Science (journal)|Science]]''.<ref name=Gallo>{{cite journal |vauthors=Gallo RC, Sarin PS, Gelmann EP, Robert-Guroff M, Richardson E, Kalyanaraman VS, Mann D, Sidhu GD, Stahl RE, Zolla-Pazner S, Leibowitch J, Popovic M |title=Isolation of human T-cell leukemia virus in acquired immune deficiency syndrome (AIDS) |journal=Science |volume=220 |issue=4599 |pages=865–67 |date=May 1983 |pmid=6601823 |doi=10.1126/science.6601823 |bibcode=1983Sci...220..865G}}</ref><ref name=Montagnier/> Gallo claimed a virus which his group had isolated from a person with AIDS was strikingly similar in [[Virus structure|shape]] to other [[human T-lymphotropic virus]]es (HTLVs) that his group had been the first to isolate. Gallo's group called their newly isolated virus HTLV-III. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the [[lymph node]]s of the neck and [[Asthenia|physical weakness]], two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV).<ref name="Basavapathruni_2007"/> As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV.<ref>{{cite book |veditors=Aldrich R, Wotherspoon G |title=Who's who in gay and lesbian history |year=2001 |publisher=Routledge |location=London |isbn=978-0-415-22974-6 |page=154 |url=https://books.google.com/books?id=9KA7_1s6w-QC&pg=PA154  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150911044550/https://books.google.com/books?id=9KA7_1s6w-QC&pg=PA154 |archive-date=September 11, 2015 |url-status=live }}</ref>

===Origins===
[[File:SIV primates.jpg|right|upright=1.35|thumb|alt=three primates possible sources of HIV|Left to right: the [[African green monkey]] source of [[Simian immunodeficiency virus|SIV]], the [[sooty mangabey]] source of [[HIV-2]], and the [[Common chimpanzee|chimpanzee]] source of [[HIV-1]]]]
The origin of HIV / AIDS and the circumstances that led to its emergence remain unsolved.<ref name="Thomas_Gilbert"/>

Both HIV-1 and HIV-2 are believed to have originated in non-human [[primate]]s in West-central Africa and were [[zoonosis|transferred to humans]] in the early 20th century.<ref name=Orgin2011/> HIV-1 appears to have originated in southern [[Cameroon]] through the evolution of SIV(cpz), a [[simian immunodeficiency virus]] (SIV) that infects wild [[Common chimpanzee|chimpanzee]]s (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies ''Pan troglodytes troglodytes'').<ref name="pmid9989410">{{cite journal |vauthors=Gao F, Bailes E, Robertson DL, Chen Y, Rodenburg CM, Michael SF, Cummins LB, Arthur LO, Peeters M, Shaw GM, Sharp PM, Hahn BH |title=Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes |journal=Nature |volume=397 |issue=6718 |pages=436–41 |date=February 1999 |pmid=9989410 |doi=10.1038/17130 |bibcode=1999Natur.397..436G|s2cid=4432185 |doi-access=free }}</ref><ref name=Keele>{{cite journal |vauthors=Keele BF, Van Heuverswyn F, Li Y, Bailes E, Takehisa J, Santiago ML, Bibollet-Ruche F, Chen Y, Wain LV, Liegeois F, Loul S, Ngole EM, Bienvenue Y, Delaporte E, Brookfield JF, Sharp PM, Shaw GM, Peeters M, Hahn BH |title=Chimpanzee reservoirs of pandemic and nonpandemic HIV-1 |journal=Science |volume=313 |issue=5786 |pages=523–26 |date=July 2006 |pmid=16728595 |pmc=2442710 |doi=10.1126/science.1126531 |bibcode=2006Sci...313..523K}}</ref> The closest relative of HIV-2 is SIV (smm), a virus of the [[sooty mangabey]] (''Cercocebus atys atys''), an [[Old World monkey]] living in coastal West Africa (from southern [[Senegal]] to western [[Ivory Coast]]).<ref name="Reeves"/> [[New World monkey]]s such as the [[Night monkey|owl monkey]] are resistant to [[Subtypes of HIV|HIV-1]] infection, possibly because of a genomic [[fusion gene|fusion]] of two viral resistance genes.<ref name=Goodier>{{cite journal |vauthors=Goodier JL, Kazazian HH |title=Retrotransposons revisited: the restraint and rehabilitation of parasites |journal=Cell |volume=135 |issue=1 |pages=23–35 |date=October 2008 |pmid=18854152 |doi=10.1016/j.cell.2008.09.022|s2cid=3093360 |doi-access=free }}(subscription required)</ref> HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.<ref name=Sharp2001>{{cite journal |vauthors=Sharp PM, Bailes E, Chaudhuri RR, Rodenburg CM, Santiago MO, Hahn BH |title=The origins of acquired immune deficiency syndrome viruses: where and when? |journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences |volume=356 |issue=1410 |pages=867–76 |date=June 2001 |pmid=11405934 |pmc=1088480 |doi=10.1098/rstb.2001.0863 }}</ref>

There is evidence that humans who participate in [[bushmeat]] activities, either as hunters or as bushmeat vendors, commonly acquire SIV.<ref name=Kalish2005>{{cite journal |vauthors=Kalish ML, Wolfe ND, Ndongmo CB, McNicholl J, Robbins KE, Aidoo M, Fonjungo PN, Alemnji G, Zeh C, Djoko CF, Mpoudi-Ngole E, Burke DS, Folks TM |title=Central African hunters exposed to simian immunodeficiency virus |journal=Emerging Infectious Diseases |volume=11 |issue=12 |pages=1928–30 |date=December 2005 |pmid=16485481 |pmc=3367631 |doi=10.3201/eid1112.050394 |first8=George |last9=Zeh |last8=Alemnji |first9=Clement |last7=Fonjungo |last6=Aidoo |first6=Michael |first7=Peter N.}}</ref> However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV.<ref name=Marx2001>{{cite journal |vauthors=Marx PA, Alcabes PG, Drucker E |title=Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa |journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences |volume=356 |issue=1410 |pages=911–20 |date=June 2001 |pmid=11405938 |pmc=1088484 |doi=10.1098/rstb.2001.0867 }}</ref> Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.<ref>{{cite journal |last1=Sharp |first1=Paul M. |last2=Hahn |first2=Beatrice H. |date=September 2011 |title=Origins of HIV and the AIDS Pandemic |journal=Cold Spring Harbor Perspectives in Medicine |volume=1 |issue=1 |pages=a006841 |doi=10.1101/cshperspect.a006841 |issn=2157-1422 |pmc=3234451 |pmid=22229120}}</ref>

Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout society, depend on the proposed timing of the animal-to-human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to {{circa}} 1910.<ref name=Worobey2008>{{cite journal |vauthors=Worobey M, Gemmel M, Teuwen DE, Haselkorn T, Kunstman K, Bunce M, Muyembe JJ, Kabongo JM, Kalengayi RM, Van Marck E, Gilbert MT, Wolinsky SM |title=Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960 |journal=[[Nature (journal)|Nature]] |volume=455 |issue=7213 |pages=661–64 |date=October 2008 |pmid=18833279 |pmc=3682493 |doi=10.1038/nature07390 |bibcode=2008Natur.455..661W}} (subscription required)</ref> Proponents of this dating link the HIV epidemic with the emergence of [[colonialism]] and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of [[genital ulcer disease]]s (such as [[syphilis]]) in nascent colonial cities.<ref name=Sousa2010>{{cite journal |vauthors=de Sousa JD, Müller V, Lemey P, Vandamme AM |title=High GUD incidence in the early 20th century created a particularly permissive time window for the origin and initial spread of epidemic HIV strains |journal=[[PLOS One]] |volume=5 |issue=4 |page=e9936 |date=April 2010 |pmid=20376191 |pmc=2848574 |doi=10.1371/journal.pone.0009936 |editor1-last=Martin |editor1-first=Darren P. |bibcode=2010PLoSO...5.9936S|doi-access=free }}</ref> While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased manyfold if one of the partners has a [[Sexually transmitted disease|sexually transmitted infection]] causing genital ulcers. Early 1900s colonial cities were notable for their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern [[Kinshasa]] were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis.<ref name=Sousa2010/>

An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single-use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.<ref name=Marx2001/><ref name=Chitnis2000>{{cite journal |vauthors=Chitnis A, Rawls D, Moore J |title=Origin of HIV type 1 in colonial French Equatorial Africa? |journal=AIDS Research and Human Retroviruses |volume=16 |issue=1 |pages=5–8 |date=January 2000 |pmid=10628811 |doi=10.1089/088922200309548|s2cid=17783758 }}(subscription required)</ref><ref name=McNeil>{{cite news | last=McNeil |first=Donald G. Jr. |author-link=Donald G. McNeil Jr. |title=Precursor to H.I.V. Was in Monkeys for Millennia |url=https://www.nytimes.com/2010/09/17/health/17aids.html |url-access=limited |quote=Dr. Marx believes that the crucial event was the introduction into Africa of millions of inexpensive, mass-produced syringes in the 1950s.&nbsp;... suspect that the growth of colonial cities is to blame. Before 1910, no Central African town had more than 10,000 people. But urban migration rose, increasing sexual contacts and leading to red-light districts. |work=[[The New York Times]] |date=September 16, 2010 |access-date=September 17, 2010 |url-status=live |archive-url=https://web.archive.org/web/20110511230019/http://www.nytimes.com/2010/09/17/health/17aids.html |archive-date=May 11, 2011 }}</ref>

The earliest well-documented case of HIV in a human dates back to 1959 in the [[Belgian Congo|Congo]].<ref name=Zhu>{{cite journal |vauthors=Zhu T, Korber BT, Nahmias AJ, Hooper E, Sharp PM, Ho DD |title=An African HIV-1 sequence from 1959 and implications for the origin of the epidemic |journal=Nature |volume=391 |issue=6667 |pages=594–97 |date= February 1998 |pmid=9468138 |doi=10.1038/35400  |bibcode=1998Natur.391..594Z|s2cid=4416837 |doi-access=free }}</ref> The virus may have been present in the U.S. as early as the mid-to-late 1950s. A 16-year-old male named [[Robert Rayford]] presented with symptoms in 1966 and died in 1969. In the 1970s, there were cases of people getting parasites and becoming sick with what was then called "[[Gay bowel syndrome|gay bowel disease]]" but is now suspected to have been AIDS.<ref>{{cite web|title=Forty years after first documented AIDS cases, survivors reckon with 'dichotomy of feelings'|url=https://www.nbcnews.com/feature/nbc-out/forty-years-after-first-documented-aids-cases-survivors-reckon-dichotomy-n1269697|access-date=June 6, 2021|website=NBC News|date=June 5, 2021|archive-date=June 6, 2021|archive-url=https://web.archive.org/web/20210606013840/https://www.nbcnews.com/feature/nbc-out/forty-years-after-first-documented-aids-cases-survivors-reckon-dichotomy-n1269697|url-status=live}}</ref>

The earliest retrospectively described case of AIDS is believed to have been in Norway beginning in 1966, that of [[Arvid Noe]].<ref>{{cite book |veditors=Lederberg J |title=Encyclopedia of Microbiology |date=2000 |publisher=Elsevier |location=Burlington, MA |isbn=978-0-08-054848-7 |page=106 |edition=2nd |url=https://books.google.com/books?id=fhC_nz8eHh0C&pg=PA106  |access-date=December 12, 2016 |archive-url=https://web.archive.org/web/20170910145825/https://books.google.com/books?id=fhC_nz8eHh0C&pg=PA106 |archive-date=September 10, 2017 |url-status=live }}</ref> In July 1960, in the wake of [[Democratic Republic of the Congo#Independence and political crisis (1960–1965)|Congo's independence]], the [[United Nations]] recruited [[French language|Francophone]] experts and technicians from all over the world to assist in filling administrative gaps left by [[Belgium]], who did not leave behind an African elite to run the country. By 1962, Haitians made up the second-largest group of well-educated experts (out of the 48 national groups recruited), that totaled around 4,500 in the country.<ref>{{cite book |url=https://books.google.com/books?id=OQ6tAgAAQBAJ |title=Geographies of the Haitian Diaspora |editor-last=Jackson |editor-first=Regine O. |page=12 |year=2011 |publisher=Routledge |isbn=978-0-415-88708-3  |access-date=March 13, 2016 |archive-url=https://web.archive.org/web/20160509142031/https://books.google.com/books?id=OQ6tAgAAQBAJ&printsec=frontcover |archive-date=May 9, 2016 |url-status=live }}</ref><ref name="Pépin">{{cite book |url=https://books.google.com/books?id=dTaMBrPBK6EC |title=The Origin of Aids |last=Pépin |first=Jacques |page=188 |year=2011 |publisher=Cambridge University Press |isbn=978-0-521-18637-7  |access-date=March 13, 2016 |archive-url=https://web.archive.org/web/20160509120414/https://books.google.com/books?id=dTaMBrPBK6EC&printsec=frontcover |archive-date=May 9, 2016 |url-status=live }}</ref> Dr. Jacques Pépin, a Canadian author of ''The Origins of AIDS'', stipulates that [[Haiti]] was one of HIV's entry points to the U.S. and that a Haitian may have carried HIV back across the Atlantic in the 1960s.<ref name="Pépin"/> Although there was known to have been at least one case of AIDS in the U.S. from 1966,<ref>{{cite news |last=Kolata |first=Gina |title=Boy's 1969 Death Suggests AIDS Invaded U.S. Several Times |work=[[The New York Times]] |date=October 28, 1987 |url=https://www.nytimes.com/1987/10/28/us/boy-s-1969-death-suggests-aids-invaded-us-several-times.html |url-access=limited |access-date=February 11, 2009 |url-status=live |archive-url=https://web.archive.org/web/20090211024256/http://query.nytimes.com/gst/fullpage.html?res=9B0DEFD6173AF93BA15753C1A961948260 |archive-date=February 11, 2009 }}</ref> the vast majority of infections occurring outside sub-Saharan Africa (including the U.S.) can be traced back to a single unknown individual who became infected with HIV in Haiti and brought the infection to the U.S. at some time around 1969.<ref name="Thomas_Gilbert">{{cite journal |vauthors=Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M |title=The emergence of HIV/AIDS in the Americas and beyond |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=104 |issue=47 |pages=18566–70 |date=November 2007 |pmid=17978186 |pmc=2141817 |doi=10.1073/pnas.0705329104  |bibcode=2007PNAS..10418566G |doi-access=free }}</ref> The epidemic rapidly spread among high-risk groups (initially, sexually promiscuous men who have sex with men). By 1978, the prevalence of HIV-1 among gay male residents of [[New York City]] and [[San Francisco]] was estimated at 5%, suggesting that several thousand individuals in the country had been infected.<ref name="Thomas_Gilbert"/>

== Society and culture ==

=== Stigma ===
{{main|Discrimination against people with HIV/AIDS}}
[[File:Ryan White.jpg|thumb|alt=A teenage male with the hand of another resting on his left shoulder smiling for the camera|[[Ryan White]] became a [[poster child]] for HIV after being expelled from school because he was infected.<ref>{{cite encyclopedia |url=https://www.britannica.com/biography/Ryan-White |title=Ryan White, an American AIDS Victim |encyclopedia=[[Encyclopædia Britannica]] |date=November 7, 2013 |access-date=July 16, 2015 |url-status=live |archive-url=https://web.archive.org/web/20150722112020/https://www.britannica.com/biography/Ryan-White |archive-date=July 22, 2015 }}</ref>]]
AIDS stigma exists around the world in a variety of ways, including [[shunning|ostracism]], [[Social rejection|rejection]], discrimination and avoidance of HIV-infected people; compulsory HIV testing without prior [[consent]] or protection of [[confidentiality]]; violence against HIV-infected individuals or people who are perceived to be infected with HIV; and the [[quarantine]] of HIV-infected individuals.<ref name="UNAIDS2006Ch4"/> Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.<ref name="Ogden">{{cite web |vauthors=Ogden J, Nyblade L |website=[[International Center for Research on Women]] |year=2005 |title=Common at its core: HIV-related stigma across contexts |url=http://www.icrw.org/docs/2005_report_stigma_synthesis.pdf |access-date=February 15, 2007 |url-status=dead |archive-url=https://web.archive.org/web/20070217044825/http://www.icrw.org/docs/2005_report_stigma_synthesis.pdf |archive-date=February 17, 2007 }}</ref>

AIDS stigma has been further divided into the following three categories:
* ''Instrumental AIDS stigma''—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.<ref name=Herek1999>{{cite journal |vauthors=Herek GM, Capitanio JP |journal=American Behavioral Scientist |year=1999 |url=http://psychology.ucdavis.edu/rainbow/html/abs99_sp.pdf |title=AIDS Stigma and sexual prejudice |access-date=March 27, 2006 |volume=42 |issue=7 |pages=1130–47 |doi=10.1177/0002764299042007006 |s2cid=143508360 |url-status=dead |archive-url=https://web.archive.org/web/20060409034211/http://psychology.ucdavis.edu/rainbow/html/abs99_sp.pdf |archive-date=April 9, 2006 }}</ref>
* ''Symbolic AIDS stigma''—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.<ref name="Herek1999"/>
* ''Courtesy AIDS stigma''—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.<ref name="Snyder">{{cite journal |vauthors=Snyder M, Omoto AM, Crain AL |title=Punished for their good deeds: stigmatization for AIDS volunteers |journal=American Behavioral Scientist |year=1999 |pages=1175–92 |volume=42 |issue=7 |doi=10.1177/0002764299042007009|s2cid=144929159 }}</ref>

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, [[bisexuality]], [[promiscuity]], prostitution, and [[Intravenous drug use (recreational)|intravenous drug use]].<ref>{{cite book |last=Sharma |first=A.K. |title=Population and society |publisher=Concept Pub. Co. |location=New Delhi |year=2012 |isbn=978-81-8069-818-7 |page=242 |url=https://books.google.com/books?id=sE-VDhEuxmsC&pg=PA242  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20150924080127/https://books.google.com/books?id=sE-VDhEuxmsC&pg=PA242 |archive-date=September 24, 2015 |url-status=live }}</ref>

In many [[Developed country|developed countries]], there is an [[AIDS and homosexuality|association between AIDS and homosexuality or bisexuality]], and this association is correlated with higher levels of sexual prejudice, such as [[Homophobia|anti-homosexual]] or [[Biphobia|anti-bisexual]] attitudes.<ref name="Herek2002">{{cite journal |vauthors=Herek GM, Capitanio JP, Widaman KF |title=HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999 |journal=American Journal of Public Health |volume=92 |issue=3 |pages=371–77 |date=March 2002 |pmid=11867313 |pmc=1447082 |doi=10.2105/AJPH.92.3.371}}</ref> There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.<ref name="Herek1999"/> However, the dominant mode of spread worldwide for HIV remains heterosexual transmission.<ref>{{cite journal |vauthors=De Cock KM, Jaffe HW, Curran JW |title=The evolving epidemiology of HIV/AIDS |journal=AIDS |volume=26 |issue=10 |pages=1205–13 |date=June 2012 |pmid=22706007 |doi=10.1097/QAD.0b013e328354622a|s2cid=30648421 |doi-access=free }}</ref>

The [[NAMES Project AIDS Memorial Quilt]] was conceived in 1985 to celebrate the lives of those who had died of AIDS when stigma prevented many from receiving funerals. It is now cared for by the [[National AIDS Memorial]] in San Francisco.

In 2003, as part of an overall reform of marriage and population legislation, it became legal for those diagnosed with AIDS to marry in China.<ref>{{cite news |title=China relaxes laws on love and marriage |url=https://www.telegraph.co.uk/news/worldnews/asia/china/1439403/China-relaxes-laws-on-love-and-marriage.html |access-date=October 24, 2013 |newspaper=The Telegraph |date=August 21, 2003 |last=Spencer |first=Richard |url-status=live |archive-url=https://web.archive.org/web/20131108082647/http://www.telegraph.co.uk/news/worldnews/asia/china/1439403/China-relaxes-laws-on-love-and-marriage.html |archive-date=November 8, 2013 }}</ref>

Between 2004 and 2020, [[Somen Debnath]] has travelled the world by bicycle promoting [[HIV]] / [[AIDS]] awareness.

In 2013, the [[National Library of Medicine|U.S. National Library of Medicine]] developed a traveling exhibition titled ''Surviving and Thriving: AIDS, Politics, and Culture'';<ref>{{cite web |url=https://www.nlm.nih.gov/exhibition/survivingandthriving/index.html |title=Exhibition – Surviving and Thriving – NLM Exhibition Program |website=U.S. National Institutes of Health, National Library of Medicine |archive-url=https://web.archive.org/web/20171201111011/https://www.nlm.nih.gov/exhibition/survivingandthriving/index.html |archive-date=December 1, 2017 |url-status=live }}</ref> this covered medical research, the U.S. government's response, and personal stories from people with AIDS, caregivers, and activists.<ref>{{cite news |url=https://www.smithsonianmag.com/history/the-confusing-and-at-times-counterproductive-1980s-response-to-the-aids-epidemic-180948611/ |title=The Confusing and At-Times Counterproductive 1980s Response to the AIDS Epidemic |last=Geiling |first=Natasha |work=Smithsonian.com |date=December 4, 2013 |access-date=March 16, 2018 |archive-url=https://web.archive.org/web/20180316152312/https://www.smithsonianmag.com/history/the-confusing-and-at-times-counterproductive-1980s-response-to-the-aids-epidemic-180948611/ |archive-date=March 16, 2018 |url-status=live }}</ref>

Stigma has proved an obstacle to the update of [[Pre-exposure prophylaxis for HIV prevention|PrEP]].  Within the MSM community, the greatest barrier to PrEP use has been the stigma surrounding HIV and gay men. Gay men on PrEP have experienced "[[slut-shaming]]".<ref>{{cite journal | vauthors = Dubov A, Galbo P, Altice F, Fraenkel L | title = Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study | journal = American Journal of Men's Health | date = August 2018 | volume = 12 | issue = 6 | pages = 1843–1854 | doi = 10.1177/1557988318797437 | pmid = 30160195 | pmc = 6199453 }}</ref><ref>{{Cite web|title=PrEP slutshaming is still alive and well – and it's harming us all|date=May 3, 2024 |url=https://www.gaytimes.com/life/prep-slutshaming/|access-date=May 15, 2024 |url-status=live |archive-url=https://web.archive.org/web/20241208094843/https://www.gaytimes.com/life/prep-slutshaming/ |archive-date=December 8, 2024}}</ref>  Numerous other barriers have been identified, including lack of quality LGBTQ care, cost, and adherence to medication use.<ref>{{cite journal |vauthors=Jin G, Shi H, Du J, Guo H, Yuan G, Yang H, et al. |title=Pre-Exposure Prophylaxis Care Continuum for HIV Risk Populations: An Umbrella Review of Systematic Reviews and Meta-Analyses |journal=AIDS Patient Care and STDs |volume=37 |issue=12 |date=December 2023 |pages=583–615 |doi=10.1089/apc.2023.0158 |pmid=38011347 }}</ref>

=== Economic impact ===
{{Main|Economic impact of HIV/AIDS|Cost of HIV treatment}}
[[File:Life expectancy in select Southern African countries 1960-2012.svg|thumb|upright=1.5|alt=A graph showing several increasing lines followed by a sharp fall of the lines starting in the mid-1980s to 1990s|Changes in life expectancy in some African countries, 1960–2012]]

HIV/AIDS affects the economics of both individuals and countries.<ref name="M117">Mandell, Bennett, and Dolan (2010). Chapter 117.</ref> The [[gross domestic product]] of the most affected countries has decreased due to the lack of [[human capital]].<ref name=M117/><ref name="Bell-et-al-2003">{{cite report |vauthors=Bell C, Devarajan S, Gersbach H |year=2003 |url=http://econ.worldbank.org/external/default/main?pagePK=64165259&theSitePK=478060&piPK=64165421&menuPK=64166093&entityID=000160016_20031110113834 |title=The long-run economic costs of AIDS: theory and an application to South Africa |access-date=April 28, 2008 |version=World Bank Policy Research Working Paper No. 3152 |format=PDF |url-status=dead |archive-url=https://web.archive.org/web/20130605151302/http://econ.worldbank.org/external/default/main?pagePK=64165259&theSitePK=478060&piPK=64165421&menuPK=64166093&entityID=000160016_20031110113834 |archive-date=June 5, 2013 }}</ref> Without proper nutrition, health care and medicine, large numbers of people die from AIDS-related complications. Before death they will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12&nbsp;million [[AIDS orphan]]s.<ref name=M117/> Many are cared for by elderly grandparents.<ref name=Greener>{{cite book |last=Greener |first=Robert |year=2002 |title=State of The Art: AIDS and Economics |chapter=AIDS and macroeconomic impact |editor-last=Forsyth |editor-first=Steven |pages=49–55 |publisher=IAEN |chapter-url=http://pdf.usaid.gov/pdf_docs/PNACP969.pdf |url-status=dead |archive-url=https://web.archive.org/web/20121012090520/http://pdf.usaid.gov/pdf_docs/PNACP969.pdf |archive-date=October 12, 2012 }}</ref>

Returning to work after beginning treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. [[Unemployment]] in people with HIV/AIDS also is associated with [[suicidal ideation]], memory problems, and social isolation. Employment increases [[self-esteem]], sense of dignity, confidence, and [[quality of life]] for people with HIV/AIDS. Anti-retroviral treatment may help people with HIV/AIDS work more, and may increase the chance that a person with HIV/AIDS will be employed (low-quality evidence).<ref>{{cite journal |vauthors=Robinson R, Okpo E, Mngoma N |title=Interventions for improving employment outcomes for workers with HIV |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=5 |page=CD010090 |date=May 2015 |pmid=26022149 |doi=10.1002/14651858.CD010090.pub2 |pmc=10793712 |hdl=2164/6021|hdl-access=free }}</ref>

By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for [[government spending|public expenditures]] such as education and health services not related to AIDS, resulting in increasing pressure on the state's finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay, and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility from the family to the government in caring for these orphans.<ref name=Greener/>

At the household level, AIDS causes both loss of income and increased spending on healthcare. A study in [[Côte d'Ivoire]] showed that households having a person with HIV/AIDS spent twice as much on medical expenses as other households. This additional expenditure also leaves less income to spend on education and other personal or family investment.<ref name="WBank">{{cite report |last=Over |first=Mead |title=The macroeconomic impact of AIDS in Sub-Saharan Africa, Population and Human Resources Department |publisher=World Bank |year=1992 |url=http://www.worldbank.org/aidsecon/macro.pdf |access-date=May 3, 2008 |archive-url=https://web.archive.org/web/20080527201655/http://www.worldbank.org/aidsecon/macro.pdf |archive-date=May 27, 2008 |url-status=dead}}</ref>

=== Religion and AIDS ===
{{Main|Religion and HIV/AIDS}}
The topic of religion and AIDS has become highly controversial, primarily because some religious authorities have publicly declared their opposition to the use of condoms.<ref>{{cite web |url=http://www.news-medical.net/health/AIDS-Stigma.aspx |title=AIDS Stigma |website=News-medical.net |access-date=November 1, 2011 |url-status=live |archive-url=https://web.archive.org/web/20111112214833/http://www.news-medical.net/health/AIDS-Stigma.aspx |archive-date=November 12, 2011 |date=December 7, 2009}}</ref><ref name="Thirty years after AIDS discovery, appreciation growing for Catholic approach">{{cite web |url=https://www.catholicnewsagency.com/news/22686/thirty-years-after-aids-discovery-appreciation-growing-for-catholic-approach |title=Thirty years after AIDS discovery, appreciation growing for Catholic approach |website=Catholicnewsagency.com |date=June 5, 2011 |access-date=November 1, 2011 |url-status=live |archive-url=https://web.archive.org/web/20111016214921/http://www.catholicnewsagency.com/news/thirty-years-after-aids-discovery-appreciation-growing-for-catholic-approach/ |archive-date=October 16, 2011 }}</ref> The religious approach to prevent the spread of AIDS, according to a report by American health expert Matthew Hanley titled ''The Catholic Church and the Global AIDS Crisis'', argues that cultural changes are needed, including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.<ref name="Thirty years after AIDS discovery, appreciation growing for Catholic approach"/>

Some religious organizations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the [[London Borough of Hackney|Hackney]]-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to many deaths.<ref name=BBC18102011>{{cite news |url=https://www.bbc.co.uk/news/uk-england-london-14406818 |title=Church HIV prayer cure claims 'cause three deaths' |date=October 18, 2011|access-date=October 18, 2011 |work=BBC News |url-status=live |archive-url=https://web.archive.org/web/20111018164909/http://www.bbc.co.uk/news/uk-england-london-14406818 |archive-date=October 18, 2011 }}</ref> The [[Synagogue Church Of All Nations]] advertised an "anointing water" to promote God's healing, although the group denies advising people to stop taking medication.<ref name=BBC18102011/>

===Media portrayal===
{{Main|Media portrayal of HIV/AIDS}}

One of the first high-profile cases of AIDS was the American gay actor [[Rock Hudson]]. He had been diagnosed during 1984, announced that he had had the virus on July 25, 1985, and died a few months later on October 2, 1985.<ref name="autogenerated4">{{cite web |last=Berger |first=Joseph |date=October 3, 1985 |title=Rock Hudson, Screen Idol, Dies at 59 |url=https://archive.nytimes.com/www.nytimes.com/library/national/science/aids/100385sci-aids.html |access-date=November 6, 2022 |website=[[The New York Times]] |archive-date=July 28, 2017 |archive-url=https://web.archive.org/web/20170728124316/http://partners.nytimes.com/library/national/science/aids/100385sci-aids.html |url-status=live }}</ref> Another notable British casualty of AIDS that year was [[Nicholas Eden, 2nd Earl of Avon|Nicholas Eden]], a gay politician and son of former prime minister [[Anthony Eden]].<ref>{{cite web |last=Coleman |first=Brian |url=http://www.newstatesman.com/blogs/brian-coleman/2007/06/lady-thatcher-gay-tory |title=Thatcher the gay icon |work=[[New Statesman]] |date=June 25, 2007 |access-date=November 1, 2011 |url-status=live |archive-url=https://web.archive.org/web/20111114044756/http://www.newstatesman.com/blogs/brian-coleman/2007/06/lady-thatcher-gay-tory |archive-date=November 14, 2011 }}</ref> On November 24, 1991, British rock star [[Freddie Mercury]] died from an AIDS-related illness, having revealed the diagnosis only on the previous day.<ref>{{cite news |url=http://news.bbc.co.uk/onthisday/hi/dates/stories/november/24/newsid_2546000/2546945.stm |title=November 24, 1991: Giant of rock dies |work=BBC On This Day |publisher=BBC News |access-date=November 1, 2011 |date=November 24, 1991 |archive-url=https://web.archive.org/web/20111021020133/http://news.bbc.co.uk/onthisday/hi/dates/stories/november/24/newsid_2546000/2546945.stm |archive-date=October 21, 2011 |url-status=live }}</ref>

One of the first high-profile heterosexual cases of the virus was American tennis player [[Arthur Ashe]]. He was diagnosed as HIV-positive on August 31, 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.<ref>{{cite web |last=Bliss |first=Dominic |url=http://www.itennisstore.com/Tennis-Latest-News/FROZEN-IN-TIME--ARTHUR-ASHE-by-Dominic-Bliss.aspx |title=Frozen In Time: Arthur Ashe |website=iTENNISstore.com |access-date=June 25, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130730170201/http://www.itennisstore.com/Tennis-Latest-News/FROZEN-IN-TIME--ARTHUR-ASHE-by-Dominic-Bliss.aspx |archive-date=July 30, 2013 }}</ref> He died as a result on February 6, 1993, aged 49.<ref>{{cite news |url=https://www.independent.co.uk/news/tributes-to-arthur-ashe-1471622.html |title=Tributes to Arthur Ashe |location=London |work=[[The Independent]] |date=February 8, 1993 |access-date=July 24, 2012 |url-status=live |archive-url=https://web.archive.org/web/20121111124842/http://www.independent.co.uk/news/tributes-to-arthur-ashe-1471622.html |archive-date=November 11, 2012 }}</ref>

Therese Frare's photograph of gay activist [[David Kirby (activist)|David Kirby]], as he lay dying from AIDS while surrounded by family, was taken in April 1990. ''[[Life (magazine)|Life]]'' magazine said the photo became the one image "most powerfully identified with the HIV/AIDS epidemic." The photo was displayed in ''Life'', was the winner of the [[World Press Photo]], and acquired worldwide notoriety after being used in a [[United Colors of Benetton]] advertising campaign in 1992.<ref>{{cite web |last=Cosgrove |first=Ben |title=Behind the Picture: The Photo That Changed the Face of AIDS |url=http://life.time.com/history/behind-the-picture-the-photo-that-changed-the-face-of-aids/#1 |website=LIFE magazine |access-date=August 16, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120814045129/http://life.time.com/history/behind-the-picture-the-photo-that-changed-the-face-of-aids/#1 |archive-date=August 14, 2012 }}</ref>

Many famous artists and AIDS activists such as [[Larry Kramer]], [[Diamanda Galás]] and [[Rosa von Praunheim]]<ref name="DeutscheWelle">{{cite web |title=Germany's most famous gay rights activist: Rosa von Praunheim |url=http://www.dw.com/en/germanys-most-famous-gay-rights-activist-filmmaker-rosa-von-praunheim-at-75/a-41514818 |work=[[Deutsche Welle]] |access-date=June 14, 2018 |archive-date=July 23, 2021 |archive-url=https://web.archive.org/web/20210723132748/https://www.dw.com/en/germanys-most-famous-gay-rights-activist-filmmaker-rosa-von-praunheim-at-75/a-41514818 |url-status=live }}</ref> campaign for AIDS education and the rights of those affected. These artists worked with various media formats.

=== Criminal transmission ===
{{Main|Criminal transmission of HIV}}
Criminal transmission of HIV is the [[intention (criminal law)|intentional]] or [[recklessness (law)|reckless]] infection of a person with the [[human immunodeficiency virus]] (HIV). Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure.<ref>{{cite web |title=HIV-Specific Criminal Laws |url=https://www.cdc.gov/hiv/policies/law/states/exposure.html |website=U.S. [[Centers for Disease Control and Prevention]] (CDC)|access-date=November 22, 2014 |date=June 30, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20141031203041/http://www.cdc.gov/hiv/policies/law/states/exposure.html |archive-date=October 31, 2014 }}</ref> Others may charge the accused under laws enacted before the HIV pandemic.

In 1996, Ugandan-born Canadian [[Johnson Aziga]] was diagnosed with HIV; he subsequently had unprotected sex with eleven women without disclosing his diagnosis. By 2003, seven had contracted HIV; two died from complications related to AIDS.<ref>{{cite web |title=Aziga found guilty of first-degree murder |date=April 4, 2009 |url=http://toronto.ctvnews.ca/aziga-found-guilty-of-first-degree-murder-1.386276 |publisher=CTV.ca News |access-date=April 9, 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131029204016/http://toronto.ctvnews.ca/aziga-found-guilty-of-first-degree-murder-1.386276 |archive-date=October 29, 2013 }}</ref><ref>{{cite news |title=HIV killer ruled dangerous offender |url=https://www.cbc.ca/news/canada/hiv-killer-ruled-dangerous-offender-1.927621 |publisher=CBC News |access-date=April 9, 2013 |url-status=live |archive-url=https://web.archive.org/web/20120903081633/http://www.cbc.ca/news/canada/story/2011/08/02/hiv-offender-aziga.html |archive-date=September 3, 2012 }}</ref> Aziga was convicted of [[first-degree murder]] and sentenced to [[Life imprisonment in Canada|life imprisonment]].<ref>{{cite news |title=A fraudster, not a murderer |url=https://nationalpost.com/opinion/columnists/story.html?id=2c6dca9a-cf31-45e0-8bab-510069a10a9d |newspaper=National Post |access-date=April 9, 2013 |url-status=dead |archive-url=http://arquivo.pt/wayback/20160515102752/http://www.nationalpost.com/opinion/columnists/story.html?id=2c6dca9a-cf31-45e0-8bab-510069a10a9d |archive-date=May 15, 2016 |date=March 30, 2010}}</ref>

===Misconceptions===
{{Main|Misconceptions about HIV/AIDS|Discredited HIV/AIDS origins theories}}
There are many [[misconceptions about HIV and AIDS]]. Three misconceptions are that AIDS can spread through casual contact, that [[Virgin cleansing myth|sexual intercourse with a virgin]] will cure AIDS,<ref>{{cite news |title='Virgin cure': Three women killed to 'cure' Aids |url=http://tribune.com.pk/story/513598/virgin-cure-three-women-killed-to-cure-aids/ |access-date=September 14, 2013 |newspaper=[[International Herald Tribune]] |date=February 28, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131015000557/http://tribune.com.pk/story/513598/virgin-cure-three-women-killed-to-cure-aids/ |archive-date=October 15, 2013 }}</ref><ref>{{cite book |last=Jenny |first=Carole |title=Child Abuse and Neglect: Diagnosis, Treatment and Evidence – Expert Consult |year=2010 |publisher=Elsevier Health Sciences |isbn=978-1-4377-3621-2 |page=187 |url=https://books.google.com/books?id=BKILM5KWFKwC&pg=PA187  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20151127054149/https://books.google.com/books?id=BKILM5KWFKwC&pg=PA187 |archive-date=November 27, 2015 |url-status=live }}</ref><ref>{{cite book |author1=Klot, Jennifer |author2=Monica Kathina Juma |title=HIV/AIDS, Gender, Human Security and Violence in Southern Africa |publisher=Africa Institute of South Africa |location=Pretoria |year=2011 |page=47 |isbn=978-0-7983-0253-1 |url=https://books.google.com/books?id=du0aR53YsYMC&pg=PA47  |access-date=June 27, 2015 |archive-url=https://web.archive.org/web/20160426060547/https://books.google.com/books?id=du0aR53YsYMC&pg=PA47 |archive-date=April 26, 2016 |url-status=live }}</ref> and that HIV can infect only gay men and drug users.<ref name="WIFANG">{{cite book|url=https://books.google.com/books?id=MNsmDAAAQBAJ&pg=PA407|title=Women's Issues for a New Generation: A Social Work Perspective|isbn=978-0190239404|publisher=Oxford University Press|last=Ukockis|first=Gail|date=2016|page=407|access-date=December 10, 2021|archive-date=December 21, 2023|archive-url=https://web.archive.org/web/20231221043736/https://books.google.com/books?id=MNsmDAAAQBAJ&pg=PA407#v=onepage&q&f=false|url-status=live}}</ref><ref name="RASEFSS">{{cite book|url=https://books.google.com/books?id=8ZnpDwAAQBAJ&pg=PA87|title=Relationships and Sex Education for Secondary Schools (2020): A Practical Toolkit for Teachers|isbn=978-1913063689|publisher=Critical Publishing|last1=Glazzard|first1=Jonathan|last2=Stones|first2=Samuel|date=2020|page=87|access-date=December 10, 2021|archive-date=December 21, 2023|archive-url=https://web.archive.org/web/20231221043746/https://books.google.com/books?id=8ZnpDwAAQBAJ&pg=PA87#v=onepage&q&f=false|url-status=live}}</ref> In 2014, some among the British public wrongly thought one could get HIV from kissing (16%), sharing a glass (5%), spitting (16%), a public toilet seat (4%), and coughing or sneezing (5%).<ref>{{cite web |title=HIV Public Knowledge and Attitudes 2014 |url=http://www.nat.org.uk/media/Files/PDF%20documents/Mori_2014_report_FINAL.pdf |website=National AIDS Trust |access-date=February 12, 2015 |page=9 |date=November 2014 |url-status=dead |archive-url=https://web.archive.org/web/20150212142740/http://www.nat.org.uk/media/Files/PDF%20documents/Mori_2014_report_FINAL.pdf |archive-date=February 12, 2015 }}</ref> Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of HIV and homosexuality in schools will lead to increased rates of AIDS.<ref>{{cite journal |vauthors=Kirby DB, Laris BA, Rolleri LA |title=Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world |journal=The Journal of Adolescent Health |volume=40 |issue=3 |pages=206–17 |date=March 2007 |pmid=17321420 |doi=10.1016/j.jadohealth.2006.11.143|doi-access=free }}</ref>

A small group of individuals continue to dispute the connection between HIV and AIDS,<ref name=Duesberg>{{cite journal |vauthors=Duesberg P |title=HIV is not the cause of AIDS |journal=Science |volume=241 |issue=4865 |pages=514, 517 |date=July 1988 |pmid=3399880 |doi=10.1126/science.3399880 |bibcode=1988Sci...241..514D}}{{cite journal |vauthors=Cohen J |title=The Duesberg phenomenon |journal=Science |volume=266 |issue=5191 |pages=1642–44 |date=December 1994 |pmid=7992043 |doi=10.1126/science.7992043 |url=http://www.sciencemag.org/feature/data/cohen/266-5191-1642a.pdf |url-status=dead |archive-url=https://web.archive.org/web/20070101111630/http://www.sciencemag.org/feature/data/cohen/266-5191-1642a.pdf  |bibcode=1994Sci...266.1642C |archive-date=January 1, 2007}}</ref> the existence of HIV itself, or the validity of HIV testing and treatment methods.<ref name=Kalichman>{{cite book |last=Kalichman |first=Seth |author-link=Seth Kalichman |title=Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy |publisher=Copernicus Books ([[Springer Science+Business Media]]) |location=New York |year=2009 |isbn=978-0-387-79475-4 |url=https://archive.org/details/denyingaidsconsp0000kali|url-access=registration }}</ref><ref name=SmithNovella>{{cite journal |vauthors=Smith TC, Novella SP |title=HIV denial in the Internet era |journal=PLOS Medicine |volume=4 |issue=8 |page=e256 |date=August 2007 |pmid=17713982 |pmc=1949841 |doi=10.1371/journal.pmed.0040256 |doi-access=free }}</ref> These claims, known as [[AIDS denialism]], have been examined and rejected by the scientific community.<ref name=consensus>{{cite web |author=Various |publisher=[[National Institute of Allergy and Infectious Diseases]] |date=January 14, 2010 |url=https://www.niaid.nih.gov/topics/HIVAIDS/Understanding/howHIVCausesAIDS/Pages/HIVcausesAIDS.aspx |title=Resources and Links, HIV-AIDS Connection |access-date=February 22, 2009 |url-status=live |archive-url=https://web.archive.org/web/20100407225045/http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/howHIVCausesAIDS/pages/hivcausesaids.aspx |archive-date=April 7, 2010 }}</ref> However, they have had a significant political impact, particularly [[HIV/AIDS denialism in South Africa|in South Africa]], where the government's official embrace of AIDS denialism (1999–2005) was responsible for its ineffective response to that country's AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections.<ref>{{cite journal |vauthors=Watson J |title=Scientists, activists sue South Africa's AIDS 'denialists' |journal=Nature Medicine |volume=12 |issue=1 |page=6 |date=January 2006 |pmid=16397537 |doi=10.1038/nm0106-6a|s2cid=3502309 |doi-access=free }}</ref><ref>{{cite journal |vauthors=Baleta A |title=S Africa's AIDS activists accuse government of murder |journal=The Lancet |volume=361 |issue=9363 |page=1105 |date=March 2003 |pmid=12672319 |doi=10.1016/S0140-6736(03)12909-1|s2cid=43699468 }}</ref><ref>{{cite journal |vauthors=Cohen J |title=South Africa's new enemy |journal=Science |volume=288 |issue=5474 |pages=2168–70 |date=June 2000 |pmid=10896606 |doi=10.1126/science.288.5474.2168|s2cid=2844528 }}</ref>

Several discredited [[conspiracy theories]] have held that HIV was created by scientists, either inadvertently or deliberately. [[Operation INFEKTION]] was a worldwide Soviet [[active measures]] operation to spread the claim that the United States had created HIV/AIDS. Surveys show that a significant number of people believed—and continue to believe—in such claims.<ref name="infektion">{{cite web |last=Boghardt |first=Thomas |title=Operation INFEKTION Soviet Bloc Intelligence and Its AIDS Disinformation Campaign |url=https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/csi-studies/studies/vol53no4/soviet-bloc-intelligence-and-its-aids.html |publisher=Central Intelligence Agency |year=2009 |url-status=dead |archive-url=https://web.archive.org/web/20110514230328/https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/csi-studies/studies/vol53no4/soviet-bloc-intelligence-and-its-aids.html |archive-date=May 14, 2011 }}</ref>

== Research ==
{{Main|HIV/AIDS research}}
HIV/AIDS research includes all [[medical research]] which attempts to prevent, treat, or cure HIV/AIDS, along with fundamental research about the nature of HIV as an infectious agent, and about AIDS as the disease caused by HIV.

Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral [[health interventions]] such as [[sex education]], and [[drug development]], such as research into [[microbicides for sexually transmitted diseases]], [[HIV vaccines]], and [[antiretroviral drugs]]. Other medical research areas include the topics of [[pre-exposure prophylaxis]], [[post-exposure prophylaxis]], and [[circumcision and HIV]]. Public health officials, researchers, and programs can gain a more comprehensive picture of the barriers they face, and the efficacy of current approaches to HIV treatment and prevention, by tracking standard HIV indicators.<ref>{{cite web |url=https://www.cdc.gov/eval/indicators/index.htm |title=Indicators – Program Evaluation – CDC |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=August 24, 2018 |archive-url=https://web.archive.org/web/20180823210732/https://www.cdc.gov/eval/indicators/index.htm |archive-date=August 23, 2018 |url-status=dead }}</ref> Use of common indicators is an increasing focus of development organizations and researchers.<ref>{{cite web |url=https://www.measureevaluation.org/community-based-indicators |title=Community-Based Indicators for HIV Programs – MEASURE Evaluation |website=measureevaluation.org |access-date=August 24, 2018 |archive-url=https://web.archive.org/web/20180825002500/https://www.measureevaluation.org/community-based-indicators |archive-date=August 25, 2018 |url-status=live }}</ref><ref>{{cite web |url=https://www.who.int/hiv/data/en/ |title=Data and statistics |website=World Health Organization |access-date=August 24, 2018 |archive-url=https://web.archive.org/web/20180902021227/http://www.who.int/hiv/data/en/ |archive-date=September 2, 2018 |url-status=deviated }}</ref>

== References ==
{{reflist}}

=== Notes ===
<!--This section is intended for works which are cited as references in shorted reference format above. Please DO NOT add anything here unless they are used as references. If you wish to adjust the referencing format used to be less confusing, rename this section etc feel free to do so. However please DO NOT remove these unless you have changed the referencing format so that these are no longer needed. As long as we include references to Mandell, Bennett, and Dolan (2010) and UNAIDS 2011, we need to define these somewhere.-->
* {{cite book | editor1-last = Mandell | editor1-first = Gerald L. | editor2-last = Bennett | editor2-first =John E. | editor3-last = Dolin | editor3-first = Raphael |title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases | year=2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA|isbn=978-0-443-06839-3 | edition = 7th |url=https://scholar.archive.org/work/z77imzos6bhytbprezvca7hazm/access/wayback/https://watermark.silverchair.com/41-2-277a.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAZswggGXBgkqhkiG9w0BBwagggGIMIIBhAIBADCCAX0GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMAuaomuvi_NJumlw3AgEQgIIBThDTgJTUHxl_S5bfxbWGGvQbB_DGg6AJIYlDrM4BLmasQkp6-pvVLXhOk14_62G__HhvAFduajMAsQTd5izB5pcwwrqpdfwBuH2Vxf1K83RmRNz2cJxhSQuwALrOcRmxdgbLkEo0E1IghVRtVnpOKxNzQxbu6FoI7x8WGQlnk61Y_jEFVtZLRD4CZrCrneZ0UimR8XeTzqc9Lj-iqFM6_0Zk3fD2e_KFFadbsY8kb9qVjN9tBxQrVsvKRYLpZx1sNpc4E8CbZ0HYAWs8N6VyAjdV5yF8L2x80mMQ_EIaeZghakmXfGTj0KbD0CSvjXHICLWsk_-i_UGF_vsC-0mIu4WOBfJxEtuAmHUgpZ4UwOOfKyuZYmCU4n0ADmPeniOozSuZstMHnsukaGthW5wGEfIMYkbzr7Q_aO2H6PrGa5uDwiBJHMoZOQ04S92I_3E }}
* {{cite book|author=Joint United Nations Programme on HIV/AIDS (UNAIDS)|author-link=Joint United Nations Programme on HIV/AIDS |title=Global HIV/AIDS Response, Epidemic update and health sector progress towards universal access|year=2011|publisher=Joint United Nations Programme on HIV/AIDS|url=http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20111130_UA_Report_en.pdf}}

== External links ==
{{Offline|med}}
* [https://www.unaids.org/en/ UNAIDS] – Joint United Nations Program on HIV/AIDS
* [https://hivinfo.nih.gov/home-page HIVinfo] – Information on HIV/AIDS treatment, prevention, and research, U.S. Department of Health and Human Services
* [https://jamanetwork.com/journals/jama/article-abstract/2688574 2018 Recommendations of the International Antiviral Society]

{{Medical resources
| DiseasesDB = 5938
| ICD11 = {{ICD11|1C60}}, {{ICD11|1C61}}, {{ICD11|1C62}}
| ICD10 = {{ICD10|B|20 || b|20}} – {{ICD10|B|24 || b|20}}
| ICD9 = {{ICD9|042}}–{{ICD9|044}}
| ICDO =
| OMIM = 609423
| MedlinePlus = 000594
| eMedicineSubj = emerg
| eMedicineTopic = 253
| MeshID = D000163
}}
{{AIDS}}
{{STD/STI}}
{{Diseases of Poverty}}
{{Viral diseases}}
{{Lymphoid and complement immunodeficiency}}
{{Subject bar|wikt=y|commons=y|voy=HIV|species=Human immunodeficiency virus|v=HIV|b=no|s=no|collapsible=y|portal1=Viruses|portal2=Medicine}}
{{Authority control}}

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