It also tells us that the health care delivery system needs to include support services to increase adherence to the difficult regimens. Long-term data suggest that it is easier to keep viral load below the level of detection than it is to get to that low level in the first place. But once there, the low level of viral activity makes it easier to suppress viral resistance for long periods. One implication of this is that if drugs can be made sufficiently tolerable and easy to use, effective lifetime therapy might be achievable. Despite these surprisingly positive advances, few well-informed people believe that the AIDS epidemic will be over any time soon.
Difficult questions remain in many areas.
One of the most striking areas of uncertainty is the degree of immune restoration people can expect in response to effective antiviral therapy. Ideally, complete suppression of HIV would permit the immune system to heal itself. This may indeed happen for some people. But it is not clear that this is possible for everyone, especially those who have already progressed to serious levels of immune deficiency. Some provided case reports of people suffering from untreatable opportunistic infections which suddenly responded after starting three-drug therapies.