HIV treatment successes lead to new challenges, opportunities in confronting chronic disease

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JAIDSSep1CoverMore than three decades after the scientific quest to confront and control HIV and AIDS began, and more than a decade after concerted efforts to make advances in treatment and prevention of the disease equitably available gathered force, results are observable worldwide, the introduction to the new issue of the Journal of Acquired Immune Deficiency Syndromes notes. Every continent has seen the success of those efforts in dropping numbers of new infections, dropping rates of death from the disease, and longer productive life spans.

The new issue of JAIDS, is the product of an effort to measure and respond to the other side of those successes: rising rates of diabetes, heart disease, cancers, liver disease, mental illness and substance abuse —  illnesses that can become more and more consequential common with age, with exposure to toxic antiretroviral treatments, and in immune systems are inflamed or suppressed by HIV. They are illnesses that will increasingly challenge health systems in low and middle income countries, and call for new responses, authors of the eight articles and two commentaries within the edition write, but at the same time, those responses can benefit from groundwork already laid in HIV responses.

Like responses to HIV globally, the edition shows, approaches to chronic diseases in low and middle income countries will need to be informed by and responsive to the environments and their conditions that affect the illnesses. That includes different symptoms and degree of stigma attached to depression and other mental disorders, lack of technology to screen for and treat cancers, and the impacts of tuberculosis, pollution and the continuing use of the inexpensive but toxic antiretroviral stavudine or d4T in low income countries.

The response to HIV has offered lessons in the value of integrated care, as well as strengthened training, research capacities and drug supply chains, authors note. Successes against HIV, the issue highlights, are just a beginning.

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