The evolution of HIV treatment guidelines: current state-of-the-art of ART.

Expert panels have provided guidelines for the treatment of HIV infection for more than a decade. The guidelines have evolved rapidly reflecting the remarkable improvements in HIV therapeutics over this time. From guidelines based mostly on expert opinion - the current guidelines are now primarily evidence-based recommendations - which the vast majority of treating clinicians accept and follow. We will highlight the major guideline recommendations for initiation of antiretroviral therapy - focusing on new data for the asymptomatic patient and those presenting with acute AIDS-related opportunistic infections. Given the number of new drugs available, we are currently able to offer virtually all patients in practice - a fully suppressive regimen, even in patients with substantial multi-drug resistant HIV. A remarkable achievement since AZT was first introduced for the treatment of HIV. This article forms part of a special issue of Antiviral Research marking the 25th anniversary of antiretroviral drug discovery and development, vol. 85, issue 1, 2010. Copyright 2009 Elsevier B.V. All rights reserved.