There is accumulating evidence from clinical trials and cohort studies that highly active antiretroviral combination therapy is effective at halting immunologic and clinical progression of human immunodeficiency virus (HIV). Its impact at a population level is less well known because the regimes may be difficult to tolerate and compliance poorer. The authors make use of population data for almost all of the HIV-infected people in Scotland in 1997 who were under clinical care and monitor their response to therapy during the first year when these effective treatments became widely available. More than two thirds of the HIV-positive patients were on some form of antiretroviral therapy during the year. The authors show that all treated groups, even those who were on changing regimes, showed net improvement in immunologic status during the year. For the group of patients on triple or quadruple therapy, there was an average increase of more than 100 CD4 cells/mm(3) over the year, with other treatment groups showing more modest, but significant, increases.

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This paper uses comprehensive national data on HIV positive patients in Scotland to carry out a needs assessment exercise for combination antiretroviral therapy. The objective of this study was to estimate the numbers of HIV positive patients in Scotland who would be eligible for combination antiretroviral therapy under current British and US guidelines and to demonstrate the impact of these different guidelines on the resources required. The proportion of the Scottish population that would be eligible for combination therapy ranged from 76% to 91%, under different guidelines for initiating therapy. We thus estimate that for countries such as Scotland, including western Europe and the United States, where a large proportion of the HIV population became infected in the early to mid-1980s, the majority of patients will be eligible for combination therapy, regardless of the guideline.