ABSTRACT

The epidemiological profile of HIV infection in Europe has changed dramatically in the course of the last few years. For the first time since the beginning of the epidemic, and in three consecutive years between 1996 and 1998, the incidence of new AIDS cases decreased in Western Europe. This positive trend is associated with progress in prevention, most especially with respect to sexual transmission and transmission through injecting drug use. But it is also related to recent advances in our understanding of the natural history of HIV disease and, above all, the diagnostic and therapeutic means available for treating infection. Quantitative viral load measurement has offered a new and powerful biological marker for prognosis and for monitoring the impact of treatment. Furthermore, with the advent of highly active antiretroviral therapy (HAART), the course of HIV infection has been greatly modified. This more aggressive therapy has shown clear success in bringing about substantial and sustained suppression of HIV viral replication and in reducing the incidence of opportunistic disease among HIV-infected individuals in shortterm studies at least. It has also provided a rationale for the earlier initiation of antiretroviral treatment.