Controversies in the treatment of HIV-1 infection

Enormous progress has been achieved in the management of chronic HIV infection, and this has led to decreased morbidity and mortality. However, it is still unclear when antiretroviral therapy should be started. Although the clinical improvement has been dramatic, the enthusiasm for aggressive and early treatment of HIV infection was soon tempered by several caveats. For example, the hope that discontinuation of treatment would be associated with virological control in most patients was not fulfilled, even when therapy was initiated very early. The results of studies of treatment interruption have been central in the debate about the timing of treatment. The results, of the Strategies for Management of Antiretroviral Therapy trial, for example, indicate that episodic treatment is associated with increased morbidity and mortality compared with continuous treatment.