New developments in long-term treatment of HIV: the honeymoon is over.

New recommendations advise starting highly active antiretroviral therapy (HAART) slightly later in the course of HIV disease compared with earlier guidelines. HAART has prolonged life in HIV patients, altering the spectrum of problems being treated. As the immune system recovers, long-term prophylaxis against some secondary infections can be discontinued. The problem, however, is that HAART also has serious long-term side effects such as lactic acidosis, lipodystrophy, and the promotion of drug-resistant strains of HIV.