ART of adult HIV infection has evolved rapidly over the last couple of decades and particularly so in the last year. Increased recognition of the chronic inflammatory nature of HIV infection and the important role this plays in promoting end organ damage has strongly influenced the revised optimal time for initiation of ART. A shift toward earlier initiation of ART is further supported by a number of clinical trials and cohort studies. Over the last several years we have also seen increased recognition of the link between optimal use of ART and decreased likelihood of HIV transmission. Taken together, these new insights have opened the door for a more aggressive strategy aimed to decreasing progression to AIDS and non-AIDS morbidity and mortality among HIV-infected individuals; and decreasing transmission of HIV infection in the community at large. Over the last few years we have also witnessed significant progress regarding our understanding of the most effective use of the available ARV agents. The effect of these new agents has been most evident in the management of experienced patients with multiple drug-resistant HIV infection. The goal of achieving full suppression (<50 copies/mL) of viral replication in this setting has now become a reality. In fact, population studies in resource-rich environments demonstrate that rates of plasma viral load undetectability among patients ever started on HAART continue to increase, leading to sustained improvements on life expectancy in this setting.