Is mpox an STI? The societal aspects and healthcare implications of a key question.

This letter explores the societal aspects and healthcare implications that underlie thinking about mpox (formerly known was monkeypox), in the 2022 outbreak, as a sexually transmitted infection (STI). The authors examine what underlies this question, exploring what is an STI, what is sex, and what is the role of stigma in sexual health promotion. The authors argue that, in this specific outbreak, mpox is an STI among men who have sex with men (MSM). The authors highlight the need of critically thinking about how to communicate effectively, the role of homophobia and other inequalities, and the importance of the social sciences.

HIV eradication: time to talk about a cure.

Since the earliest years of the epidemic, a cure has been the elusive "holy grail" of HIV/AIDS research. Several false starts and failed attempts gave rise to pessimism, and as efforts focused on improving antiretroviral therapy (ART) and managing its complications, the idea of HIV eradication faded into the background.

HIV/HCV coinfection: a new era of treatment.

Hepatitis C is a life-threatening illness that can progress to cirrhosis, liver cancer, and end-stage liver failure. An estimated one-third of HIV positive people are coinfected with hepatitis C virus (HCV), and HCV-related liver disease is a major cause of death for people with HIV in the era of effective antiretroviral therapy (ART). HCV has made headlines recently due to the approval of the first direct-acting antiviral (DAA) agents, which promise to revolutionize hepatitis C treatment. Researchers at the 2011 Conference on Retroviruses and Opportunistic Infections (CROI) and the Infectious Disease Society of America (IDSA) annual meeting presented the first data from studies of these drugs in HIV/HCV coinfected people.

Inflammation, immune activation, and HIV.

Inflammation is a broad term for what happens in the body when the immune system is activated to counter a threat. A healthy immune response is key to good health, but ongoing immune activation and inflammation due to a persistent threat such as chronic HIV infection can lead to many different problems throughout the body.

HIV and the brain.

Right from the early years of the epidemic, researchers have recognized that HIV can affect the brain. Before effective antiretroviral therapy (ART), people with AIDS were susceptible to a variety of opportunistic infections of the brain, as well as HIV-related dementia. With the advent of effective combination ART in the mid-1990s, the prevalence of both conditions declined dramatically in areas with widespread access to treatment. Less severe neurocognitive impairment, however, remains common. In fact, some research indicates that the frequency of HIV-related neurological impairment is rising as people with HIV live longer.

Getting the most from available antiretroviral therapies.

Two decades after the approval of the first antiretroviral drugs, combination HAART has dramatically lowered the risk of illness and death for people with HIV. The year 2007 was another milestone, witnessing the approval of the first agents in two new anti-HIV drug classes--CCR5 antagonists and integrase inhibitors--that provide new options for treatment-experienced patients. Today, however, the anti-HIV drug pipeline is relatively sparse, with no blockbusters in the foreseeable future. While the first HIV maturation inhibitor, bevirimat, continues to slowly make its way through clinical trials, another once-promising agent that works by a completely novel mechanism, Koronis Pharmaceuticals' KP-1461, was recently put on hold after laboratory tests indicated that it did not demonstrate the expected antiviral activity.

When to start antiretroviral treatment: a changing equation.

The decision about when to start antiretroviral treatment is among the most vexing puzzles in the field of HIV management.HIV begins killing CD4 T-cells--key players in the body's immune response--from the time of initial infection, yet many HIV positive people go for years without experiencing clinical symptoms. Antiretroviral drugs effectively suppress viral replication and enable CD4 cell recovery, but also can lead to side effects that are at best bothersome and at worst debilitating or even fatal. While the optimal time to begin treatment for many diseases is as soon as possible after infection, in the case of HIV the decision involves balancing the benefits of preventing immune system decline--as well as other harmful effects of HIV infection that are only beginning to be understood--against the inconvenience, expense, and health risks associated with antiretroviral therapy.

Human papillomavirus.

A majority of sexually active adults carry the human papillomavirus (HPV), but until recently, this virus received little public attention. This changed in 2006 with the approval of a new vaccine that can prevent infection with certain types of HPV, and thereby reduce the risk of cervical cancer.

New approaches to HIV prevention.

Just as the 1996 International AIDS Conference in Vancouver ushered in the era of effective combination antiretroviral therapy and the 2000 meeting in Durban focused on the HIV/AIDS epidemic in the developing world, the 2006 conference (held August 13-18 in Toronto) may be remembered as the one that brought HIV prevention to the fore. Political considerations aside, it has become abundantly clear that efforts to promote behavioral change--the so-called "ABC" approach, relying on abstinence, marital fidelity ("be faithful"), and condoms--has failed to stem the tide of new HIV infections. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), some four million people worldwide were newly infected in 2005. Even as antiretroviral therapy begins to trickle down to people in resource-limited countries, public health experts estimate that about four people become infected with HIV for each person who starts treatment.