In order for anti-retroviral therapy to be effective, the drugs must be used taken very consistently and correctly. Correct use means that the drugs must be taken at appropriate intervals (with or without food as indicated), at correct doses and in correct combinations. The goal of antiretroviral therapy is to improve survival and decrease morbidity by suppressing viral replication and lowering the amount of virus in the body (also called viral load.) Sub-optimal therapy (therapy that does not sufficiently suppress HIV replication, such as taking less than 95% of doses correctly) often leads to viral resistance, and treatment failure, and loss of effectiveness of an entire class of agents.

Preventive treatment (or prophylaxis)

When a person's CD4 count gets low (<200), he or she may should be given prophylaxis (e.g. antibiotics) to prevent serious illness. Preventive treatment exists for two of the most common and dangerous opportunistic infections: pneumocystis carinii pneumonia (PCP) and mycobacterium avium complex (MAC). In addition, some people take preventative therapy for fungal and other viral diseases (e.g. CMV), but these forms of treatment are more controversial.

Studies show that the use of anti-retroviral therapy and the prevention of specific HIV-related opportunistic infections, has been associated with dramatic decreases in the incidence of opportunistic infections, hospitalizations, and deaths among HIV-infected persons.

Problems with treatment:

1.	Anti-retroviral therapy may fails in as many as 30 - 50 % of patients.
2.	Currently available drugs often have inconvenient dosing schedules. Patients may be taking as many as 20 - 30 pills a day at different intervals and often with different rules (with or without food etc.)
3.	Currently available drugs often have significant side effects. These may vary from one person to the next. Some people experience few or no side effects at all, while some experience mild and manageable side effects. Others have quite severe and even potentially lethal side effects. Some of the more common side effects include nausea, diarrhea, fever, rash, fatigue, liver toxicity, lipodistrophy, and peripheral neuropathy, and lactic acidosis.
4.	Anti-retroviral therapy is quite very expensive. The cost of the pills alone (not including clinic visits and monitoring tests) can be up to $15,000 per year; however in WA state (and many other jurisdictions in the US and in developed countries) all HIV + persons have access to medical care. We cannot stress enough that medical services are available, regardless of job, money or current insurance coverage. Getting hooked up with medical care as early as possible greatly improves the chances of having a long and healthy life. Anyone in need of care should call the HIV/STD Hotline at (206) 205-7837 for a referral.
5.	Despite medical services provided by WA state, many people avoid testing and/or care for a variety of reasons including lack of health insurance, family care burdens, language barriers, fear of the stigma of HIV/AIDS, fear of discrimination, and myths/fears about medical care.

There are several new treatments currently being studied. In the future, patients should have treatment regimens that cause fewer side effects, require fewer pills and have more convenient dosing schedules. Public Health and community organizations are also working to reduce other barriers to health care.

Vaccines

An effective and widely available preventive vaccine for HIV may would be our best long term hope to control the global pandemic. Currently, many companies, governments and community organizations are developing and testing different vaccine strategies. But the scientific challenges involved in developing an HIV vaccine are daunting, and many social, ethical and other issues make this goal difficult to reach. One of the major problems is money. Major pharmaceutical firms are not interested in investing the large amounts of money involved in to developing a vaccine because vaccines (needed most by the poorest nations in the world) are not financially profitable.

Post Exposure Prophylaxis

Post exposure prophylaxis or PEP, is a prevention intervention in which antiretroviral drugs are given to a person in the first few hours (or within 3 days) following a potentially high-risk exposure to HIV:

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