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The goals of antiretroviral therapy are a sustained suppression of the HIV replication, the regeneration of CD4-T cells, an improvement in immune system function and thereby the reduction in opportunistic infections and tumors. The Swiss HIV Cohort Study described the significant increase of CD4-T cells under treatment in the first large observational study with over 5,000 patients with a significant impact on prognosis. The study of Egger et al. [2] shows the change in outcome and prognosis with new combination treatments. The proportion of patients who survived increased from 10% to 70% [2]. An updated analysis shows that prognosis was even better in the years to come (Figure 1). This change in outcome is due, as pathophysiological studies showed later on, not only to an increase in numbers of CD4-T cells but also in an increase in the function of immune cells which can again combat pathogens responsible for opportunistic diseases.

As one can imagine the change of prognosis in the late nineties led to a very positive reaction if not euphoria first by scientists and physicians followed later when trust in therapies was built up also in patients.

Knowing one’s medical fate in advance - in that time as a doctor one had to be very cautious with statements about prognosis. In this context it is important to mention that even in view of the excellent prognosis of nowadays HIV treatments a patient may go through different phases of perception regarding his disease as explained below. Vice versa the perception of doctors is important too and essential to initiate treatment. For example, a large study of the Swiss HIV Cohort Study could demonstrate that treatment was withheld for some intravenous drug users [3]. The perception at that time was that the treatment was too complicated for this group of patients and would therefore be not successful. We might say that knowing the others fate in advance should be also always viewed critically and adapted if wrong.

Fig. 1. The figure demonstrates the proportion of patients surviving in different time periods after the first CD4-T cell count has been measured between 100-200 cells/µl. Note that only a few patients survived in the early years (1988-1990), whereas over 90% of patients survive in recent years. Figure courtesy of Matthias Egger, University of Bern, Switzerland.