Introduction

The first cases of the human immunodeficiency virus (HIV) were first described in the early 1980s, prompting an aggressive search for a cure for this deadly virus. In 1987, the approval of zidovudine, the first medication approved for the treatment of HIV, ushered in a new age in HIV management. As our understanding of HIV evolved, new therapies gradually emerged in the 1990s, as did hope that a curative medication regimen may be discovered.

Single-drug nucleoside reverse transcriptase inhibitor therapy initially conferred only 6 to 12 months of benefit to patients before viral resistance rendered this approach ineffective. Therapeutic strategy then evolved into dual-drug therapy, which extended benefit to 2 to 3 years. Eventually the use of a three-drug regimen (i.e., highly active antiretroviral therapy, or HAART) in the mid 1990s became the predominant regimen and remains the standard of care today.

Along with these new drug developments came new frustrations, however, manifested as mutated and resistant HIV strains, high pill burdens, and significant toxicities. These multi-drug regimens subsequently have been refined over the past 10 years, to the point where many patients are able to maintain an intact immune system with no detectable virus on single-pill, triple-drug coformulated, minimally toxic antiretroviral therapy (ART) regimens. While the goal of HIV eradication has remained elusive, the modern age of ART has commonly rendered HIV disease a chronic condition that, when ideally managed, can lead to a reasonable life expectancy in patients who once considered this infection a death sentence.