The clinical challenge of the HIV epidemic in the developing world

Lancet. 1993 Oct 23;342(8878):1037-9. doi: 10.1016/0140-6736(93)92885-w.


PIP: A move away from a narrow, top-down focus on acquired immunodeficiency syndrome (AIDS) is urged to maximize the impact of scarce medical services in developing countries. The current emphasis on researching and treating the opportunistic infections characteristic of full-blown AIDS has produced a mood of powerlessness and hopelessness in the medical community as well as the general population. In developing countries, however, early human immunodeficiency virus (HIV) disease is far more common than AIDS and more amenable to successful medical interventions. Non-AIDS patients tend to present with infections such as pulmonary or lymphatic tuberculosis or pneumococcal pneumonia that respond well to standard, inexpensive therapies. Tuberculosis, pneumonia, and salmonellosis are endemic in impoverished, overcrowded Third World communities so clinical initiatives targeted at their treatment would benefit both seropositive and seronegative residents. A strategy that emphasizes an improved clinical outcome for all who present with common treatable infections would further boost staff morale by overcoming the clinical hopelessness associated with efforts to save patients in the late stages of the disease process. Health ministries will have to commit extra staff and resources to meet the increased demand for short-course tuberculosis treatment, and it may be advisable to integrate tuberculosis and bacteriology laboratories. Patients with end-stage HIV disease can be provided with home-based symptom relief, nutritional supplementation, and psychological support.

Publication types

  • Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology*
  • Acquired Immunodeficiency Syndrome / prevention & control
  • Africa / epidemiology
  • Developing Countries*
  • Disease Outbreaks* / prevention & control
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • Humans