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How did highly active antiretroviral therapy change HIV/AIDS outcomes in the 1990s?

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AIDS Scanning electron micrograph of HIV-1 virions (green) budding from a cultured lymphocyte. Multiple round bumps on the cell surface represent sites of virion assembly and budding.

Introduced in 1996, highly active antiretroviral therapy (HAART) fundamentally transformed the management of HIV/AIDS by utilizing a combination of three or four reverse transcriptase and protease inhibitors.12

Because HIV rapidly develops resistance to single-drug treatments, this combination approach became necessary for effective viral suppression. By reducing the plasma viral load to undetectable levels, HAART allows the immune system to reconstitute itself, which has resulted in a marked decline in mortality rates from HIV infection in the United States and other industrialized nations.12

Patients successfully treated with HAART are often able to avoid the severe, AIDS-associated conditions that previously characterized the final stage of the disease. However, the therapy does not eradicate the virus, which persists in latent reservoirs, and it requires strict adherence to prevent the development of drug-resistant strains. While HAART significantly improved outcomes, its high cost has limited its availability in many regions most severely affected by the epidemic.1