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Patients with human immunodeficiency virus (HIV) infection present for ED evaluation at various stages of infection with a wide spectrum of illnesses involving virtually every organ system.

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As of December 2007, approximately 25 million individuals had died of HIV-related illnesses throughout the world, and an estimated 33.2 million people are living with HIV infection/acquired immunodeficiency syndrome (AIDS). The epidemic has disproportionately affected the poorest countries due to a lack of resources for implementing effective prevention programs and inadequate access to therapies known to delay progression of HIV-related diseases. HIV prevalence is greatest in sub-Saharan Africa, with 22.5 million people infected. The epidemic is growing fastest in Central Asia and Eastern Europe, where the number of new HIV cases increased from 30,000 in 1995 to 1.4 million in 2004.1 The Joint United Nations Programme on AIDS predicts that by 2020, HIV will be responsible for more than one third of all infectious disease–related deaths worldwide.2

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In the U.S., the Centers for Disease Control and Prevention (CDC) estimate that 1.1 million people are currently living with HIV and that approximately 56,000 new HIV infections occur each year. As of February 2009, 580,000 deaths from HIV/AIDS have been reported.3 Although mortality from HIV infection dropped by >70% from 1996 to 1999 (a decline largely attributable to the advent of highly active antiretroviral therapy, or HAART), rates of decline have slowed more recently.

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Risk factors associated with HIV infection include homosexuality or bisexuality, injection drug use, heterosexual exposure, receipt of a blood transfusion prior to 1985, and maternal HIV infection (risk for vertical and horizontal maternal-neonatal transmission). Changes in the distribution of AIDS cases in adults and adolescents by mechanism of transmission since the start of the HIV epidemic are shown in Table 149-0.1.4 In homosexual and bisexual men, rates of newly acquired HIV infection increased by 26% from 2004 to 2007, although this may be partially attributed to an increase in testing in that population. During this same period, rates of HIV diagnoses increased 9% and 14% for males and females, respectively, due to high-risk heterosexual activity. Rates of new HIV infection have continued to rise among young disadvantaged minority populations (many of whom use the ED for both primary and emergency care). During the past several years, the highest percentage increases in reported AIDS cases occurred among women, non-Hispanic blacks, and residents of southern states. In 2005, HIV/AIDS was the fourth leading cause of death among black men aged 25 to 44 years and was the third leading cause of death among black women in the same age group.

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Table Graphic Jump Location
Table 149-0.1 Trends in the Distribution of Acquired Immunodeficiency Syndrome Cases by Mechanism of Transmission in Adults and Adolescents (Percentage of Cases) 

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