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People infected with HIV are asymptomatic for a variable number of years during which time they are HIV antibody positive and infectious. Many people will be able to work normally during this period, especially if they are not aware of their HIV infection. An early occupational health concern that otherwise perfectly well people may suddenly develop AIDS dementia and pose a risk to themselves and others at work does not seem to have been borne out, as AIDS dementia is nearly always accompanied by other features of AIDS. Nevertheless, AIDS is a cause of dementia occurring in relatively young people, and this may be a limiting factor for work fitness in some cases.
In rich nations there has been very substantial modification of the natural history of HIV infection.1 Highly active antiretroviral therapy (HAART) is usually a cocktail of three types of drugs. With good compliance to HAART, people with HIV or AIDS can remain well for many years. However, these effective drugs are very expensive. Even with recent price reductions for developing countries, they cannot be afforded and the infrastructure needed for their use and monitoring is lacking. The prognosis of AIDS in developing countries remains extremely poor, with death within two years being usual.
THE AIDS EPIDEMIC WORLDWIDE
Estimates on the worldwide AIDS epidemic are available from, for example, the UNAIDS website.2 At the end of 2000, the number of adults and children estimated to be living either with HIV or AIDS worldwide was estimated to be 36.1 million (fig 1). Of these, 25.3 million are in sub-Saharan Africa, and 5.8 million are in South and South East Asia. The situation in some countries of South and South East Asia has the potential to become very much worse, given the huge population in this area. From the 1970s through to …
Based on Ernestine Henry Lecture, Royal College of Physicians, Faculty of Occupational Medicine, 18 September 2000