The changing landscape of HIV epidemiology and management.

Antiretroviral therapy (ART) has transformed infection by human immunodeficiency virus (HIV), from almost universally fatal into a manageable condition. With expansion of ART coverage, global HIV-related deaths have fallen by 69% since their peak in 2004. ART is highly effective at reducing HIV transmission; people with fully suppressed viral load do not transmit the virus sexually. Treatment is becoming easier, with better tolerated drugs, reduced side effects and combination tablets. Here, we review the changing landscape of HIV epidemiology and treatment, focusing on the impact of ART and the latest developments in long-acting injectable HIV therapy. These agents offer the potential for treatment and prevention without requiring patients to take daily tablets, including for multidrug-resistant infections. HIV epidemic control is on the horizon for many countries due highly effective prevention programmes. However, emerging funding challenges due to geopolitical realignment is threatening the substantial gains of the last 20 years.