The population effectiveness of highly active antiretroviral therapy: are good drugs good enough?

Despite the success of highly active antiretroviral therapy (HAART) at reducing mortality from HIV infection, there is evidence that it is not reaching the all of the population that needs it, even in the developed world. To be maximally effective at the population level, all persons with HIV infection must be diagnosed; those persons with an indication for HAART must enter care, must receive HAART, and then must adhere to appointments and, finally, HAART itself. There is considerable evidence that significant portions of the population infected with HIV have not completed all of these steps of HIV care even in the developed world. Although new medications to treat HIV are certainly needed, significant improvements in viral, immunologic, and clinical outcomes could be achieved from improving timely diagnosis, access to HAART, and adherence to appointments, as well as adherence to HAART.