The changing epidemiology of HIV in 2013.

Purpose of reviewWe sought to review the recent epidemiology of HIV-1 and to identify emerging challenges in HIV surveillance and epidemic control.Recent findingsThere is increasing evidence that HIV epidemics are in decline among general populations worldwide. Critical exceptions to these trends are HIV epidemics among key populations globally; the HIV epidemics in Eastern Europe and Central Asia in injecting drug using populations; the continued high burden epidemics of sexually transmitted HIV among young women and girls in southern sub-Saharan Africa, and young men who have sex in men (MSM) in the America, Asia, and Africa. In the new era of ART access, prevalence measures over time are less reliable and new approaches to the measurement of incident infection will be critical to assess trends. The implementation of expanded options for HIV prevention, reducing vertical transmission, and treatment as prevention, will shift focus from individuals to population-level impact. Strong surveillance and information systems will be necessary to meet these expanded surveillance needs.SummaryThe epidemiology of HIV infection is changing, dynamic, complex, and progress in epidemic control remains markedly uneven. Without addressing the components of global HIV, in which disease rates continue to expand, current efforts are unlikely to succeed.