Monotherapy and combo lite: HIV wasn’t ID’d as the culprit behind AIDS until 1983, and meds to suppress the virus emerged slowly. So people had no choice but to take one or two drugs at a time, with only CD4 counts to gauge success or failure.
Hit hard, hit early with HAART (Highly Active Antiretroviral Therapy): With the approval of the first protease inhibitors and a non-nuke (Viramune/nevirapine), there were three different classes of drugs. Combining meds from several classes revolutionized treatment by disrupting HIV at various points in its reproductive cycle. Viral-load testing became available, so treatment failure could be spotted early, before CD4s began falling.
In the early days of HAART, docs put people on meds at HIV diagnosis or soon after. The theory: prolong health, and possibly eradicate the virus, by suppressing HIV as early and quickly as possible—when CD4 cells drop to 500, said U.S. treatment guidelines.
2001 to the present
Conservative HAART: Wait for CD4 counts between 200 and 350 before starting meds. This has been the standard (reflected in revised U.S. treatment guidelines) ever since adherence problems (which can lead to drug resistance) and side effects (both short- and long-term) showed the downside of HIV meds.
2007 to the future?
Hit hard/early with HAART, the sequel: As long-term studies suggest that some of what we’ve considered to be med side effects are actually damage done by HIV itself, several researchers think it’s time to begin starting meds earlier. Sound