Throughout the world until the mid-1990s, HIV infection was invariably fatal, with a median survival of one to two years after diagnosis of AIDS. Symptomatic HIV disease and AIDS imposed significant burdens on healthcare budgets, in addition to the often immeasurable societal costs. Now, for some, the availability of more effective antiretroviral therapies has transformed the HIV/AIDS epidemic. Mortality and AIDS diagnoses have fallen precipitously since widespread introduction of these treatments.1,2 Evidence to date suggests that the effectiveness of antiretroviral therapy has persisted.3 Mother-to-child HIV transmission can be effectively controlled, so that in the developed world paediatric HIV infection is rare. In developed countries, antiretroviral therapy is one of the most cost-effective interventions for treatment of a chronic disease.4 These unequivocal improvements are largely unprecedented for an infectious disease only 20 years old.
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