Introduction

As the severity of the disease began to be understood and it became apparent that a worldwide pandemic was underway, our resourcefulness in the face of a new infectious agent was soon to be tested. In the early years following its description, AIDS was universally fatal and there seemed to be no cure in sight. Even after discovery of HIV, the causative agent of AIDS, treatment was primarily supportive and mortality rates continued to be high. While initially hopes for development of more effective therapy and an effective vaccine were high, infection as well as lack of political interest delayed much needed research funding. The first anti - retroviral medication, azidothymidine (AZT), was approved in 1987, 6 years after the first reports of AIDS. Over the next 10 years, better understanding of the disease, both scientifically and publicly, led to greater funding and accelerated research. Multiple new medications were approved by the Food and Drug Administration (FDA) in the US, and by 1997, regimens known as highly active antiretroviral therapy (HAART) gave new hope of transforming HIV infection from a death sentence to a chronic, manageable disease. With more effective long-term treatment and the ability to prevent or reduce transmission of HIV via early treatment after exposure and prenatal prophylaxis for affected mothers, a more optimistic view has arisen in the fight against HIV. Although development of an effective HIV vaccine remains elusive, worldwide focus on prevention, early diagnosis, and treatment have made significant impacts on the HIV pandemic, especially in developed countries. However, significant challenges remain, especially in devel - oping countries that are often fraught with problems of political unrest, general lack of education regarding HIV/AIDS, and social and cultural stigmata that hinder safe sex practices. Furthermore, side-effects of HAART, many of which are addressed in other chapters in this book, may cause individuals with HIV infection to discontinue taking med - ications, which can result in a recrudescence of immunodeficiency. Finally, and potentially most disheartening, recent data show that many men who exposed. Thus, it behoves physicians and caretakers to maintain a high degree of vigilance about the possibility of HIV/AIDS in their patients as the virus continues to maintain a high degree of prevalence in many countries, including the US.