The "ART for All" initiative, initiated in 2003, has significantly improved the provision of antiretroviral therapy (ART) to a larger portion of the population. The "test and treat" approach allows individuals testing HIV positive to commence ART upon presentation to the outpatient department, eliminating the need for delay. This approach is based on global targets set by WHO and UNAIDS known as "90-90-90," which mandates that 90% of HIV cases are identified, 90% receive treatment, and 90% achieve viral suppression. 

 In 2022, Botswana achieved remarkable success by surpassing the 90-90-90 target and achieving a staggering 95-95-95. India's progress remains modest, with only a fraction receiving treatment and achieving viral suppression. 

 Guidelines emphasize Tenofovir/Lamivudine/Dolutegravir (TLD) as the primary first-line ART, covering over 95% of the HIV-positive population. Alternatives like Tenofovir/Lamivudine/Efavirenz 400 (TLE 400) offer comparable virologic suppression with reduced side effects, facilitating better adherence and overall healthcare outcomes.

 India now offers three primary regimens: TLD, TLE 400, and TAF/FTC/BIC. Currently, as per guidelines, Tenofovir/Lamivudine/Dolutegravir (TLD) stands as the primary first-line regimen in India, with Tenofovir/Lamivudine/Efavirenz 400 (TLE 400) as an alternative second-line option.

 Trials show that two-drug regimens, particularly those incorporating Dolutegravir as a backbone, yield comparable efficacy to traditional three-drug regimens. These advancements offer several advantages, including reduced toxicity and improved adherence, and simplified treatment regimens could enhance patient compliance and overall treatment outcomes.

 Dolutegravir (Doan), a small, 75-milligram pill, could revolutionize HIV treatment by offering a tablet-free regimen for Hepatitis B-negative patients. However, patients are becoming tired of daily tablet regimens, leading to a trend towards injectable antiretroviral therapy. Studies have shown that transitioning patients from traditional oral regimens to monthly injectables maintain virologic suppression rates at 93% over one year. Adverse events associated with injections, such as mild injection site reactions, are generally manageable and do not require discontinuation.

 Recent studies have explored optimal strategies for patients failing first-line or second-line antiretroviral therapy, with the Dawning study recommending Doir-based regimens as the backbone for second-line therapy in India. The Nadia study examined the effectiveness of transitioning patients failing on Tenofovir/Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) to either Doir or Darunavir, suggesting that Darunavir could be a viable alternative to Doir in certain cases.

 Prep regimens have gained popularity in India, especially among men who have sex with men, who are at high risk of incident HIV infection. Oral Prep Toob FTC is used to protect young, vulnerable men, particularly transgender men, transgender women, and prostitutes who cannot guarantee the use of condoms. Injectable Cabot Gravair is now being replaced as the prep regimen for HIV-negative people at high risk of sexual transmission of HIV.

 A post-exposure prophylaxis study by the Doxy Pep study found that people living with HIV or at high risk of infection with STDs can get infected with other sexually transmitted infections, such as syphilis, gorilla, and chlamydia. A study published in AMM found a 55% reduction in goria, 80% reduction in chlamydia., and almost 60 to 65% reduction in syphilis new syphilis diagnosis when using Doxy Cycling 200 mg single dose after every episode of condomless sex within 72 hours.

DoxyCline postexposure prophylaxis is expected to be available for bacterial SDI, while TLD is a good postexposure prophylaxis regimen for people who are afraid of acquiring HIV post-condomless sex. Doxy Pep's trial showed that Doxy Cycling 200 mg single dose after every act of condomless sex helps in the prevention of gorilla, syphilis, and chlamydia among people living with HIV. 

 A study published in NM found that oral Pitavastatin was given to a population of people aged 40 to 75 years with low to moderate risk of cardiovascular disease, reducing the risk of cardiovascular illness, angina myocardial infection, stroke, and peripheral vascular disease by almost 35% over five years. Statins work by lowering LDL and inflammatory markers, making them a good choice for long-term therapy alongside antiretroviral therapy. 

 A new study published in the Lancet compared the need for a double dose of Dolutegravir when using rifampin-based anti-tubercular therapy for HIV TB co-infection.

New approaches to drug development prioritize enhancing safety and resistance characteristics in current antiretroviral classes. Additionally, efforts are directed towards discovering medications with innovative mechanisms like attachment/post-attachment inhibitors, capsid inhibitors, maturation inhibitors, and nucleoside reverse transcriptase translocation inhibitors. Combination therapies aim to enhance adherence, while treatment simplification strategies focus on reducing dosing frequency.

In terms of multi-drug resistant HIV treatment, there is hope in the availability of new drugs, which attaches to the GP 1220 of the virus and prevents it from attacking CD4 T helper cells. Monoclonal antibodies can be used in multi-drug resistant HIV infections when combined with an optimized background regimen Fostemsavirr and Lenacapavir,  can achieve virologic suppression even in 60% of multi-drug resistant HIV patients.