Anders Sonnerborg

Ferdinand Mugusi

Ferdinando Dianzani

Giuseppe Ippolito

Jay A Levy

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AIDS Research and Treatment
Volume 2013, Article ID 731983, 3 pages
http://dx.doi.org/10.1155/2013/731983
Editorial
AIDS and HIV Infection after Thirty Years
Giuseppe Ippolito,1 Jay A. Levy,2 Anders Sonnerborg,3
FerdinandMugusi,4 and Ferdinando Dianzani5, 6
1 Department of Medicine, AIDS Research Institute, National Institute for Infectious Diseases Lazzaro Spallanzani,
Via Portuense, 292-00149 Rome, Italy
2 AIDS Research Institute, University of California at San Francisco, San Francisco, CA, USA
3Unit of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
4Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
5Department of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense, 292-00149 Rome, Italy
6 Sapienza University of Rome, Piazzale Aldo Moro, 5-00185 Rome, Italy
Correspondence should be addressed to Giuseppe Ippolito; giuseppe.ippolito@inmi.it
Received 11 December 2012; Accepted 11 December 2012
Copyright © 2013 Giuseppe Ippolito et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Acquired Immunode�ciency Syndrome (AIDS), caused by
the Human Immunode�ciency virus (HIV), �rst appeared
in Western countries in 1981 as a disease leading to a high
death rate. It initially approached 100% aer 5–10 years
of the diagnosis. As evidenced from articles in this special
issue, much progress has been made in the global �ght
against HIV/AIDS. Valuable information has been gathered
on the virus and the host immune response to this new
human pathogen. Successful therapies have been developed
and approaches to control HIV spread have been instituted.
e epidemic, however, continues to affect the Western
countries and, importantly, the international community in
resource-limited countries. According the United Nations
Programme on HIV/AIDS (UNAIDS) estimates, published
for the World AIDS Day 2012, 34 million (31.4–35.9) people
are living with HIV, 2.5 (2.1–2.8) million people became
new infected with HIV, and 1.7 (1.5–1.9) million died from
AIDS-related illnesses. (UNAIDS Global report: UNAIDS
report on the global AIDS epidemic 2012. UNAIDS/JC2417E
available at http://www.unaids.org/en/resources/campaigns/
20121120_globalreport2012/).
In the last 30 years since the recognition of the disease,
clinicians, scientists, public health officials, policy makers,
and volunteers have worked together to take care of people
with HIV infection, to identify new drugs and evaluate their
efficacy, to better understand the virus and to assess its
pathogenicity, to �nd new tools to diagnose and prevent HIV
infection, to assess the role of coinfections, and tomitigate the
adverse events from antiretroviral treatment. Essentially, they
have focussed on directions to manage patients according to
a model of clinical excellence.
is large investment of resources has given impressive
results and represents a welcomed scienti�c success. As noted
in this issue, aer 3 decades, AIDS has become at least for
many industrialized countries a chronic disease affording
patients a near-normal lifestyle and survival, if adequately
treated [1, 2].is year, UNAIDS reported an unprecedented
acceleration in the clinical response to HIV/AIDS with more
than a 50% reduction in the rate of new HIV infections
even in some low- and middle-income countries. Impressive
results have also been reached in resource-limited countries
in terms of access to treatment. According to the above-
mentioned UNAIDS Global report, worldwide the number
of people with access to antiretroviral therapy has increased
by 63% in the last 24 months. In sub-Saharan Africa the
number of people on antiretroviral treatment has increased
by 59% in the last two years and the number of AIDS-
related deaths has been reduced by one-third in the last six
years. Nevertheless, the clinical spectrum today, even with
therapy, can include cardiovascular disease [3], infectious
and noninfectious cancers [4], osteopenia/osteoporosis [5],
liver and renal disease [6], and neurocognitive decline [7].
2 AIDS Research and Treatment
Importantly, the treatments for HIV/AIDS are very
expensive and difficult to afford in resource-limited coun-
tries. Even in high-income countries, drug expenditure for
treatment of HIV/AIDS today represent, according to recent
estimates, 62,4% of total cost versus a mean of 20% for other
chronic diseases and the cost per person treated is 38% higher
than the treatment of cancer.
Global economic value of DALYs by HIV/AIDS is 21.6%
of the value for cancer and 26% of heart diseases [8]. Concern
over the costs of health care is universal and experience
gained from studies of HIV/AIDS could help to in�uence the
model of access to care for other clinical conditions.
For this special issue, a policy to have papers from
researchers from resource-limited countries was adopted.
e articles chosen cover several areas of research in different
countries. In the paper by M. Harris et al., the problem of
cost-effectiveness of highly active antiretroviral therapy for
Multidrug-Resistant (MDR) HIV has been evaluated. e
authors consider the possibility for patients with MDR to
achieve full and durable viral suppression along with the
cost of different options for treatment.e proposed solution
could be a basis for careful planning and strategic use of
antiretroviral drugs.
In A. E. Horace review, the evolution of the pharmacists’
role in treatment of HIV-infected patients is presented.
Facilitation of access to treatment of HIV-infected patients
is discussed with attention to increasing effectiveness and
adherence to prescribed medicines. In addition, measuring
the CD4+ cell count and viral load revolutionized the
possibility for monitoring the evolution of infection in
HIV-infected persons. CD4+ cell counts represent the �rst
successful application on a large scale of this technique
in western and African countries. In A. Akinbami et al.
paper, the authors present an evaluation, based on CD4+ cell
count, of the percentage of HIV-infected people who require
antiretroviral therapy at enrollment in an HIV treatment and
care center in Nigeria.
Neurological manifestations, including HIV-dementia
and HIV-associated neurocognitive disorder (HAND), are
among the most threatening complications of HIV infection
[7]. Although their incidence has decreased among people
who have access to combination antiretroviral treatments,
new neurological problems are being observed in countries
where treatments are available. ey are related to both
changes in the natural history of old diseases as well as
emergence of novel entities.
Two contributions on this topic are presented in this
issue. In O. O. Oshinaike et al. report, the performance of
the minimental state examination (MMSE) and international
HIV dementia scale (IHDS) in assessing neurocognitive
function in treatedHIV/AIDS has been compared in Nigeria.
In the second paper, M. L. Giancola et al. investigate the
effect of antiretroviral therapy and single antiretroviral drugs
on the cerebrospinal �uid HIV-RNA levels in HIV-infected
patients affected by neurological disorders enrolled in a large
multicentric Italian cohort.
Oral lesions and other oral manifestations are frequent in
persons withHIV infection. Candidiasis is a common �nding
and lesions of the oral cavity occur in about one-third of
patients with AIDS-associated Kaposi’s Sarcoma (KS). Two
clinical studies on this topic by the same group in South
Africa appear in this issue.e �rst characterizes the features
of oral HIV-KS and describes the patterns of evolution of the
disease [9]. e second compares the prevalence and the rate
of progression of chronic periodontitis in HIV-positive and
-negative subjects [10].
Today the efficacy of antiretroviral drugs and the impres-
sive changes in the progression of the HIV disease allow
mothers perinatally infected to have almost a universal
prevention in transmitting HIV infection to their offspring
[11]. In this regard, M. L. Badell and M. Lindsay review
various aspects related to maternal, obstetrical, and neonatal
risks associated with pregnancy in perinatally HIV-infected
mothers.
e determinants of the different time course for pro-
gression of HIV infection is still not clearly de�ned. �. C.
Gaardbo et al. describe immunological features of controllers
and long-term nonprogressors where knowledge on their
ability to controlHIV infection could lead to the development
of immune therapies or a therapeutic vaccine.
With the introduction of antiviral therapy, deaths in
HIV-infected people have been dramatically reduced with
an improved quality of life for treated patients [12]. In this
regard, A. Stewart et al. investigated the changes that occur
in the care of persons living with HIV in a hospice.
ese papers published in this special issue present excit-
ing, insightful observations on the state of HIV/AIDS and
the emergence of future topics of research for investigators.
In this rapidly developing �eld of study, interdisciplinary
and challenging research, performed in both industrialized
and resource-limited countries, can bring critically important
information for the life and social sciences, for public health,
and for overall health care. Development of new preventive
and therapeutic strategies is being encouraged as well as new
models of health care. e aim of this special issue is to
contribute to the development of knowledge on HIV/AIDS,
to recognize the great progress many facets of medicine have
made towards its complete control, and to recognize the
challenges that still remain.
Acknowledgments
Unfortunately Ferdinando Dianzani, who initiated the effort
for this special issue, passed away on 12 April 2012 before
�nishing this work. During his lifetime, he witnessed the
progress made in the past thirty years of activities for �ghting
AIDS. His remarkable career as a virologist spanned almost
5 decades. Ferdinando Dianzani will be fondly remembered
as a respected scientist, a strong leader, skilled virologist,
athlete, excellent teacher and proud Italian. Drawing on years
of experience spent in the �eld, FerdinandoDianzani became
a world-renowned expert in virology, with a remarkable role
in his research on the measles virus, on the role of interferons
in infectious diseases and on the pathogenesis of HIV/AIDS.
His contributions to virology will survive in the thou-
sands of students trained by him across his long academic
AIDS Research and Treatment 3
career, as well as his colleagues and friends throughout
the world.
Giuseppe Ippolito
Jay A. Levy
Anders Sonnerborg
Ferdinand Mugusi
Ferdinando Dianzani
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Editorial AIDS and HIV Infection after Thirty Years

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Editorial AIDS and HIV Infection after Thirty Years

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