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The discovery and deployment of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is one of the most extraordinary achievements in recent biomedical history. Between 1996 and 2012, ART averted an estimated 6.6 million AIDS-related deaths worldwide.1 For HIV-infected individuals with access to ART, life expectancy at diagnosis now approximates that of uninfected individuals—a remarkable feat. These extraordinary successes, however, are tempered by the necessity of lifelong drug therapy. Many patients struggle with adherence in the face of competing priorities, both within the clinical context (comorbidities) and beyond (food insecurity, housing, substance abuse, and other challenges). The drugs can cause health issues in the form of cumulative toxicities. Nations and health systems struggle to find the resources needed to provide long-term therapy. The challenges of resistance and drug-drug interactions add considerable complexity to the provision of care.
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JAMA: 2014-07-19, Vol. 312, No. 4, Author Reading
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