The world must build on three decades of scientific advances to enable a new generation to live free of HIV/AIDS

Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations

Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.

And the Band Played on: Before and After

In fall 1987, Randy Shilts published his second book, "And the Band Played on: Politics, People, and the AIDS Epidemic." The jacket proclaimed that "the epidemic spread widely because the federal government put budget ahead of the nation's welfare; health authorities placed political expediency before the public health; and scientists were more often more concerned with international prestige than saving lives." In the Prologue Shilts wrote, "The bitter truth was that AIDS did not just happen to America-it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health." This essay reviews the controversial book published by Randy Shilts 30 years ago in light of some of the events that have followed. First, the context and content of the book-and reactions to its publication-are summarized. Secondly, several major developments after publication of the book are noted. Thirdly, a critical assessment of the author and his work is offered in an era when some politicians and physicians in the United States are imagining "an AIDS-free generation."

Preparedness for emerging infectious diseases: pathways from anticipation to action

Emerging and re-emerging infectious disease (EID) events can have devastating human, animal and environmental health impacts. The emergence of EIDs has been associated with interconnected economic, social and environmental changes. Understanding these changes is crucial for EID preparedness and subsequent prevention and control of EID events. The aim of this review is to describe tools currently available for identification, prioritization and investigation of EIDs impacting human and animal health, and how these might be integrated into a systematic approach for directing EID preparedness. Environmental scanning, foresight programmes, horizon scanning and surveillance are used to collect and assess information for rapidly responding to EIDs and to anticipate drivers of emergence for mitigating future EID impacts. Prioritization of EIDs - using transparent and repeatable methods - based on disease impacts and the importance of those impacts to decision-makers can then be used for more efficient resource allocation for prevention and control. Risk assessment and simulation modelling methods assess the likelihood of EIDs occurring, define impact and identify mitigation strategies. Each of these tools has a role to play individually; however, we propose integration of these tools into a framework that enhances the development of tactical and strategic plans for emerging risk preparedness.

Bioethical challenges with HIV treatment as prevention

To best realize the opportunities afforded by treatment as prevention, important ethical challenges must be addressed, including those related to acceptability, safety, and effectiveness, as well as alternatives. Absent universal access to quality antiretroviral treatment, safety, fairness, and allocation must also be considered.

Emerging infectious diseases in 2012: 20 years after the institute of medicine report

Twenty years ago (1992), a landmark Institute of Medicine report entitled "Emerging Infections: Microbial Threats to Health in the United States" underscored the important but often underappreciated concept of emerging infectious diseases (EIDs). A review of the progress made and setbacks experienced over the past 2 decades suggests that even though many new diseases have emerged, such as SARS (severe acute respiratory syndrome) and the 2009 pandemic influenza, significant advances have occurred in EID control, prevention, and treatment. Among many elements of the increase in the capacity to control EIDs are genomics-associated advances in microbial detection and treatment, improved disease surveillance, and greater awareness of EIDs and the complicated variables that underlie emergence. In looking back over the past 20 years, it is apparent that we are in a time of great change in which both the challenge of EIDs and our responses to them are being transformed. Recent advances support guarded optimism that further breakthroughs lie ahead.