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(See the Review Article by Tang et al, on pages 862–75.)

The rollout of antiretroviral therapy (ART) in resource-limited settings has had a profound impact on AIDS-related morbidity and mortality. According to the World Health Organization, >5 million human immunodeficiency virus (HIV)–infected persons in low- and middle-income countries were receiving ART at the end of 2009, the most recent year for which data are available [1]. In South Africa alone, the availability of ART has reduced mortality from AIDS by 3.3% since the peak in 2006, saving an estimated 700 000 life years [2].

Despite this impressive progress, the World Health Organization estimates suggest that only one-third of persons who meet guidelines for ART are receiving treatment [2]. Funding for ART has come from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund for AIDS, Tuberculosis and Malaria, other donor programs and, in many countries, local governments. The increasing number of patients in need of ART and the growing number requiring more costly second-line regimens have strained the budgets of AIDS treatment programs at the same time that the global economic crisis has sapped the resources of donor countries. Rising healthcare costs and shrinking revenues have constrained AIDS budgets in wealthy countries, too. As a result, pressure is mounting to make greater use of less-expensive regimens in order to maximize access to ART.

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HIV/AIDS
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