Natural history of HIV

Medical knowledge of human immunodeficiency virus (HIV) has evolved rapidly in the 40 years since acquired immune deficiency syndrome (AIDS) was first described, leading to increased understanding of the disease, its immunology and its clinical manifestations. Effective antiretroviral therapy (ART) now allows people with HIV to have normal life expectancies and not pass their infection on. Advances in treatment continue and new long-acting injectable therapies are now available. Worldwide, strategies including universal HIV testing and the roll-out of ART have reduced transmission. Of people with HIV, 87% are now aware of their status and the number of new HIV diagnoses is falling. Despite this, nearly half of patients in the UK present with advanced HIV, with a CD4 count <350 cells/mm³ and this population is increasingly affected by frailty. It remains essential that all healthcare providers are alert to the possibility of HIV in their patients, and ensure individuals are tested and treated before the development of HIV-related infections, cancers and complications.