HIV has an impressive ability to replicate, mutate, and diversify, so developing drugs or vaccines that can fully contain the virus is a challenge. The only consistently successful way to prevent replication of HIV is to administer a potent combination regimen that contains at least two and preferably three antiretroviral drugs. Fortunately, with more than 20 antiretroviral drugs currently available, it is easy to construct such regimens for patients who are treatment naive.

However, a considerable number of patients have not had the chance to achieve full viral suppression despite access to antiretroviral drugs. These people are not well defined, but they generally began monotherapy with zidovudine in the early 1990s, and were sequentially exposed to each new drug as it became available (figure⇓). This sequential use of suboptimal regimens led to the emergence of multidrug resistant HIV. These patients are often referred to as being in “deep salvage” and are at risk for disease progression.

This year, we may witness a dramatic shift in how these patients are managed. For the first time in the HIV epidemic, three new agents have been developed for the management of drug resistant virus. They are the HIV integrase inhibitors, R5 inhibitors, …