In the mid-1990s, the clinical care of patients with HIV infection changed fundamentally as a result of the development and introduction of effective antiretroviral therapy (ART). This led to dramatic reductions in the numbers of patients under care with advanced immunodeficiency. Over subsequent years care has continued to evolve for a number of reasons, including:

• a switch in paradigm to manage HIV infection as a long-term, treatable condition;• a decline in the proportion of patients with uncontrolled viral replication and/or viral drug resistance;• an increase in the number of available antiretroviral drugs and changes in the use of diagnostics to support ART, including drug resistance, viral tropism and human leucocyte antigen (HLA) B* 5701 testing and therapeutic drug monitoring;• an increased recognition of non-AIDS-defining HIV morbidities, including cardiovascular, metabolic, renal and bone diseases, and certain non-AIDS-defining malignancies;• a change in the epidemiology, with an increase in the proportion of women and Black African patients attending for care;• an increase in the number of older individuals with HIV infection and the broadened challenge of managing HIV infection in patients with a range of comorbidities;• increasing cost pressures and a need to demonstrate cost-effective management;• an increased incidence of coinfection, including sexually transmitted hepatitis C;• changing epidemiology of other sexually transmitted infections.