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Acquired immunodeficiency syndrome (AIDS) was first recognized in 1981 and is caused by human immunodeficiency virus (HIV-1). HIV-2 causes a similar illness to HIV-1 but is less aggressive and has so far been restricted mainly to western Africa. HIV/AIDS is acquired through exposure to infected body fluid, particularly blood and semen; the most common modes of spread are sexual, parenteral (blood or blood product recipients, injection drug users, and occupational injury) and vertical (mother to fetus).

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HIV/AIDS is now the second leading cause of death in the world, with a global prevalence of 0.8%. More than 33 million people are living with HIV/AIDS, with 2.7 million new infections and 2 million AIDS-related deaths reported in 2007.1 The vast majority of deaths have occurred in sub-Saharan Africa, where more than 13 million children have been orphaned and approximately two-thirds of the global HIV/AIDS burden exists.1 In the United States, more than 1 million people are HIV infected, and infection rates are increasing rapidly in many parts of the world, notably south Asia and eastern Europe.2

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Many cultural and social factors determine regional patterns of HIV/AIDS disease and associated infections.3 In the United States and northern Europe, the epidemic has predominantly been in men who have sex with men. In southern and eastern Europe, Vietnam, Malaysia, northeast India, and China, the incidence has been greatest in injection drug users, but in Africa, the Caribbean, and much of southeast Asia, the dominant routes of transmission have been heterosexual and from mother to child (vertical).

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The epidemic in industrialized nations is also changing. In these countries, heterosexual transmission is now the dominant route of infection. For example, in the United Kingdom, the number of new HIV/AIDS diagnoses among heterosexuals has outnumbered those among homosexual and bisexual men since 1999; 54% of new infections in 2005 were acquired heterosexually. The disease is increasingly seen in women, and in the United States, the proportion of female HIV/AIDS patients rose from 7% in 1985 to 23% in 1998.4

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Various heart diseases have been documented in up to 40% of autopsy cases and during life by echocardiography in approximately 25% of patients with AIDS (category C disease; see below). However, many of these pathologic lesions are mild, and HIV-related heart disease probably causes symptoms in fewer than 10% and death in fewer than 2% of all patients with HIV infection. Common cardiovascular manifestations of HIV infection are listed in Table 93–1.

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Table 93–1. Cardiac Manifestations of HIV/AIDS

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