Significant Challenges Facing HIV Practitioners

The care of patients with HIV infection has become possibly the most rewarding and yet most challenging specialty in medicine. The advances over the past 10–15 years have been extraordinary and probably are unrivaled by those for the treatment of any other contemporary disease. However, treatment-related decisions are complex, and the penalties for mistakes are harsh. There are now 24 antiretroviral drugs, with 2 new agents introduced in 2007. PubMed lists >6000 articles about HIV treatment that have been published within the past year. It is becoming impossible to keep up. This supplement to the Journal of Infectious Diseases discusses 5 areas that are central to HIV care and that are characterized by especially challenging issues. Authoritative reviews are provided regarding the management of initial therapy, failed therapy, adherence issues, hepatic coinfection, and neurological complications. Martin S. Hirsch [1] reviews the latest information about when to start antiretroviral therapy (ART) during chronic infection, as well as the drugs to use and whether to start therapy during primary infection and what to use in the initial regimen. He also addresses the value of new and investigational therapies for treatment-naive patients.