Why START? Reflections that led to the conduct of this large long-term strategic HIV trial.

HIV infection complications; ANTIRETROVIRAL agents; CARDIOVASCULAR diseases risk factors; MEDICAL cooperation; POPULATION geography; RESEARCH; RESEARCH funding; RESPIRATORY function tests; COMORBIDITY; FIBROSIS; BONE density; EARLY medical intervention; CD4 lymphocyte count

The author reflects on the Strategies for Management of AntiRetroviral Therapy (SMART) study, which examines the benefits and risks of ART in HIV treatment. Issues investigated in the study are discussed including existence of causal link between inflammation and cardiovascular disease, whether ART should be initiated early or after the HIV has impaired the immune system and the risks of AIDS.