Expanding access to HIV antiretroviral therapy among marginalized populations in the developed world.

Since its introduction in the mid-1990s, the benefits of antiretroviral therapy for the management of HIV disease have been well established [1,2]. New antiretroviral regimens have proved to be effective in decreasing HIV plasma viral load, improving CD4 cell counts, and have substantially altered the natural history of HIV infection [3,4]. As a result, substantial improvements in HIV-related morbidity and mortality have been documented among persons receiving appropriate antiretroviral regimens, and in many areas of the world, HIV infection is increasingly being viewed as a chronic and manageable illness [5,6]. Nevertheless, the clinical management of HIV disease continues to present major challenges. Treatment of HIV disease with the regimens that are presently available aims to prevent progression to AIDS or death by reducing plasma HIV RNA to as low a level as possible for as long as possible [7,8]. The eradication of HIV from the individual is not considered possible with presently available therapeutic agents. As such, persons undergoing treatment for HIV disease must take a daily regimen of at least three antiretroviral drugs (i.e., highly active antiretroviral therapy, or HAART), and follow a scheduled dosing protocol that often involves coordination of dietary intake [9]. To date, a great deal of effort has been expended in evaluating patient, physician, and