Mortality trends: toward a new definition of AIDS?

HIV disease today looks very different than it did two decades ago when the first cases were described--at least in developed countries where highly active antiretroviral therapy (HAART) is widely available. Most HIV positive people receiving treatment no longer succumb to opportunistic illnesses (OIs) that take advantage of their ravaged immune systems. Instead, people with HIV now live longer and die from a wide variety of other causes. In other words, a growing number of positive people will die with HIV, but not of HIV. In the HAART era, HIV positive people and their health-care providers must now think about the cumulative impact of chronic HIV infection and the longterm side effects of treatment. In addition, as effective antiretroviral therapy extends the lives of people with HIV, they become prone to conditions that normally occur with greater frequency as people age (such as heart disease, diabetes, and osteoporosis) and progressive conditions that may take decades to cause significant illness or death (such as chronic viral hepatitis). Given the shifts in the types of conditions now seen in people with HIV, it may be time to rethink the definition of AIDS.