Changes in the clinical epidemiology of HIV infection in the United States: implications for the clinician.

The HIV epidemic in the United States continues to affect racial/ethnic minorities disproportionately and is increasing among men who have sex with men. Late HIV diagnosis remains common. To reduce HIV transmission and facilitate early linkage to care and antiretroviral treatment, the Centers for Disease Control and Prevention recommends universal voluntary HIV screening for all persons ages 13 to 64 years in public and private care settings. Recent studies demonstrate dramatic reductions in morbidity and mortality with widespread use of highly active combination antiretroviral therapy (cART), and some document improved outcomes when cART is initiated with CD4 cell count >/= 350 cells/mm(3). As patients live longer, they are increasingly affected by chronic diseases, notably cardiovascular and renal disease, diabetes, and non-AIDS-defining cancers. Providers should ensure patients undertake preventive lifestyle changes (eg, smoking cessation, exercise, weight loss, dietary modification) and undergo recommended screening tests to reduce their risk for these important comorbidities.