Critical issues of HIV treatment in the era of highly active antiretroviral therapy

Despite dramatic declines in HIV-associated morbidity and mortality as a result of highly active antiretroviral combination therapies (HAART), several issues regarding the management of patients with HIV-infection remain problematic. This article aims at describing the strategic thoughts in a very dynamic field with rapid development of pathophysiological as well as clinical and drug-related knowledge. In particular, the optimal use of antiretroviral medication remains an issue of intense research debate and numerous aspects must be highlighted, such as the best time to start, the occurrence and management of adverse events, problems with resistant virus, salvage therapy and individualisation of therapy with inherent problems in conducting large randomised trials. Eradicating HIV seems to be out of our perspective and this implies that we have to adapt our management to the one of a chronic disease.