Meeting the immense need for HAART in resource-poor settings

According to recent estimates, 42 million people worldwide suffer from infection with HIV, the causative agent of AIDS.1 Less than 5% of these live in high-income countries where highly active antiretroviral therapy (HAART) is widely available. Falling prices of antiretroviral drugs and increasing donor support from affluent countries should enable a larger portion of the world’s HIV-infected population to gain access to HAART, but public health organizations are being relatively slow, maybe even hesitant, about its large-scale implementation. This relates primarily to concerns regarding feasibility and sustain-ability of HAART in resource-poor settings. Clinical opinion leaders start from the underlying assumption that HAART is only effective when it is administered under guidance of laboratory markers. Here, we present the view that laboratory marker guidance might increase the efficiency of HAART, but at the same time slows down access to treatment in countries that lack a clinical and laboratory infrastructure.