在过去的30年中，获得的免疫缺陷综合征（AIDS）已从毁灭性且知名度不佳的疾病转变为可治疗且管理良好的疾病。最初被描述为“a strange illness of unknown origin” by Jacques Leibovitch, the turning point occurred in 1983 when human immunodeficiency virus (HIV) wasfirst recognizedas theretroviruscausing the disease. Thirty years on, AIDS can be successfully managed by antiretroviral treatment, which stops disease progression, helps prevent transmission, and substantially improves the quality of life of infected individuals. To mark the progress in HIV treatment over the last 30 years,BMC Medicine, together withBMC Biology和Retrovirology,has launched a new文章集合, which covers the progress made towards eradicating the virus, along with the challenges that remain.

Despite the tremendous advances in treating HIV, thereis still no cure for the disease, and there are many controversies in the field. One of the major debates is when to start antiretroviral therapy; although treating patients with various combinations of highly active drugs suppresses the virus and reduces inflammation, there are concerns over the long-term side effects of therapy, and experts are divided over whether or not treatment should be deferred until a patient’sCD4 cell countdrops below a certain level. CD4 counts, which are indicative of damage to the immune system, fall over time in most patients, and those with levels below 200 are at risk of developing life-threatening illnesses.

本周发表的两篇辩论文章中解决了何时开始治疗的争议BMC Medicineas part of our HIV collection. Ricardo Franco andMichael Saagfrom the University of Alabama at Birmingham争论that treatment should be started as soon as possible in HIV-infected individuals to prevent viral replication, reduce comorbidities and to help stop the spread of infection. By contrast,Jens Lundgren和哥本哈根大学的同事recommend仅当大多数患者的CD4计数下降350次以下时，开始治疗。Lundgren及其同事强调了与终身抗逆转录病毒疗法相关的潜在长期毒性，认为除非我们有良好的随机试验证据，否则未知的风险：早期治疗的益处比率是未知的，因此我们应该采用更谨慎的方法。

这“when-to-start” question has been debated extensively at recent HIV therapy congresses. Lundgren and Saag presented their arguments at theEleventh International Congress on Drug Therapy in HIV Infection，在British HIV Association (BHIVA) Spring meeting,卡尔·科恩（Cal Cohen）fromHarvard Vanguard Medical Associates主张早期开始,而卡罗琳·萨宾（Caroline Sabin）fromUniversity College Londonadvocated waiting until later. Interestingly, international guidelines differ in their recommendations; in line with Lundgren and colleagues’ argument, theBhiva指南advise starting therapy when CD4 counts drop below 350. On the other hand, theUS guidelinessuggest that therapy should be initiated as soon as possible, regardless of CD4 count.

尽管有多年的辩论，但尚未达成关于何时开始抗逆转录病毒疗法的共识。这Strategic Timing of Antiretroviral Therapy (START) trialhas been designed to assess the benefits and harms of deferring treatment until CD4 counts drop below 350, and is currently recruiting participants. We eagerly await the results of this trial, and look forward to the results of further investigations with longer follow-up periods to ascertain which is the best long-term approach. Our HIV article collection remains open for submissions, and if you would like your research to be considered for publication inBMC Medicine作为集合的一部分，请发送预审查询bmcmedicineeditorial@biomedcentral.com.