Epidemiology of acquired immunodeficiency syndrome: advancing to an endemic era

Acquired Immunodeficiency syndrome (AIDS) is now endemic in the United States. Human immunodeficiency virus (HIV) is the leading cause of death in U.S. adults aged 25-44 years. While the rate of infection among men who have sex with men has stabilized, that among women, minorities, and young people is increasing. Improved methods for identifying these subpopulations at risk are needed. More than half the people infected with HIV do not know that they are. Recent studies demonstrate rapid viral replication during clinically asymptomatic disease and support the need for early initiation of combination antiretroviral therapy to slow disease progression and to improve patient longevity. However, significant numbers of individuals, particularly those at highest risk, continue to be diagnosed late in their illness. A recently approved oral test for HIV-1 samples mucosal transudate and provides a less invasive, but equally reliable, alternative to blood testing that may increase the acceptability and accessibility of HIV testing. Nonetheless, it remains to be determined whether this oral testing approach will have a significant public health impact among risk groups with low access to screening and care.