How do we treat HIV and what are the challenges?

This chapter explores the evolution, current landscape, and pipeline of HIV treatment, highlighting the critical role of antiretroviral therapy (ART) in suppressing viral replication and extending life expectancy. It details the shift from early sub-optimal treatments, such as AZT monotherapy, to current combination regimens, including long-acting injectable therapy and agents in development. While ART is highly effective, challenges remain including side effects, drug resistance, and treatment fatigue. This chapter focuses on the importance of adherence, highlighting its central role in achieving viral suppression, prevention of drug resistance, and maintaining long-term health. We review barriers to adherence, including stigma, mental health, structural inequalities, and treatment access. We detail strategies to support people living with HIV (PLWH), including patient education, individualised treatment approaches, peer support, strong clinician–patient relationships and the importance of addressing medical and psychosocial health concerns within a holistic model of care.