The changing clinical features of HIV-1 infection in the United Kingdom

Despite advances in antimicrobial and anti-retroviral treatment in the past decade, the natural history of HIV-1 infection remains largely unchanged. Clinical monitoring has led to the introduction of effective prophylaxis of Pneumocystis carinii pneumonia and has facilitated the early detection and treatment of opportunistic infections. Pneumocystis carinii pneumonia now makes up a smaller proportion of first AIDS defining diagnoses than before prophylaxis was introduced. The proportion made up by more unusual opportunistic infections and malignancies, that occur later in the course of the disease, is growing. Late stage HIV disease--which is now complicated by infections with organisms of low pathogenicity, often combined with systemic Kaposi's sarcoma or lymphoma--presents major problems in clinical management. Further changes in the clinical features of HIV-1 infection may be expected in the future as more effective antimicrobial and anti-retroviral treatments are developed.