The introduction of antiretroviral therapy in the 1990s transformed the lives of people with HIV and AIDS.1 2 Whereas AIDS was once a rapidly progressive disease, with a life expectancy often measured in months, it has now become yet another chronic disease where effective, well tolerated, and widely available treatment allows those affected to lead relatively normal lives. Ninety years ago, a similar therapeutic breakthrough, the isolation of insulin, transformed the lives of those with type 1 diabetes. Now, models based on empirical data estimate that a 25 year old person with HIV, when appropriately treated with antiretroviral therapy, can expect to enjoy a median survival of 35 years, remarkably similar to that for someone of the same age with type 1 diabetes.3

The benefits of antiretroviral therapy are not confined to the West. Although the mortality of patients starting therapy in sub-Saharan Africa is substantially higher than for those in industrialised countries, patients who start treatment when they have a high CD4 …