Emergency Medicine and Primary Care
The history of HIV as we became aware of it started approximately 30 years ago, in 1981, when the first cases of infection were reported in Los Angeles and New York in some gay people and IV drug users. In March of 1987, the FDA approved the first antiretroviral drug for treatment of HIV. In 1995 the FDA approved the first protease inhibitor and outlined the beginning of a new era in highly active antiretroviral treatment (HAART). Once incorporated into clinical practice HAART treatment caused an immediate decline between 60% and 80% in rates of AIDS related mortality and morbidity.
As of 2017, the CDC reports 36.9 million people are living with HIV worldwide - 35.1 million adults, 1.8 million children. Only 75% of those people living with HIV know their status. With the development of standard antiretroviral therapy (ART), the treatment of HIV infection became clinically manageable. However, strong adherence to treatment and lifetime commitment to taking the medications is necessary. Unfortunately, over time, a large percentage of patients stop taking their medications and this leads to a progression from HIV to AIDS. As we have learned, multiple factors such as access to food, housing, transportation, social and emotional support, religious beliefs, and the stigma of HIV affect adherence rates in this population. It appears that recurrent difficulties in meeting the basic needs are directly impacting patients desire and ability to adhere to treatment. Given the magnitude of the problem and available solutions, it is vital to identify and address key factors affecting the adherence to treatment with the goal of compliance, minimizing the risk of transmission and decreasing the financial and emotional burden of HIV/AIDS related mortality and morbidity.
Emanuel TC. Unmet Social Determinants in HIV Positive Population As Key Factors in Adherence to Treatment and Suppression of Viral Load. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(3).
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