Progress in HIV therapeutics and the challenges of adherence to antiretroviral therapy.

The impressive and gratifying advances in antiretroviral therapy have benefited many with HIV disease who are fortunate to have access to these complicated and expensive regimens. It is still early in the era of HAART, and the future of therapeutics is not clear. No other infectious disease has required lifelong therapy, and the challenges of equitable treatment of this chronic infectious disease are daunting; not the least among them is lifelong adherence to medications. To maximize the potential of each drug and drug combination, targeted efforts to increase and maintain excellent adherence in the real-world clinical setting are essential, and are second in importance only to the more widespread availability of HAART and continued development of new and more potent agents. The theoretical basis for improving adherence exists, but more substantial research is required. The aim of providing and maintaining therapeutic benefit necessitates that clinicians develop and employ practical and relevant strategies to support antiretroviral adherence. The marriage of biology and behavior that characterizes clinical care in HIV disease is nowhere more challenging for clinicians than in the issue of adherence, but also nowhere more gratifying.