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New and potent drugs are urgently needed for the salvage therapy of HIV-infected patients. The protease inhibitors Tipranavir and TMC114, which have high potency against multidrug-resistant viral strains, are the most promising drugs for the near future. How important they will be in salvage therapy cannot be predicted at this time. New points of attack in the viral replication cycle have been defined. Substances belonging to the groups of integrase and maturation inhibitors are in the early stages of clinical development.

We had some good news in the last year: Tenofovir received its FDA approval, a new class of antiretrovirals, the fusion-inhibitors, entered phase III trials and there are some promising agents in the pipeline of the pharmaceutical laboratories. The major issue in the development of new drugs is the antiretroviral activity. One of the "winners" here is TMC-125, a new NNRTI. But people focus also on the side-effects of the HAART, especially on long-term toxicity. One example is Atazanavir, a protease inhibitor which doesn't show any increase in cholesterin or triglycerides. But all the exciting news drugs have to prove their real potential in large phase III trials.

Despite of 18 licensed antiretroviral drugs in Germany, there is an increased pressure for development of new substances and new targets in the treatment of HIV positive patients. Multidrug resistance and poor pharmacokinetics are the biggest problems we have to fight with. But there is hope for resolving these challenges. Second generation drugs like FTC and DPC 083 with once a day dosage and a high resistance barrier are tested in clinical trials. In addition new classes of HIV drugs are available in phase III trials (T-20 fusion inhibitor). So the future will provide us with some new effective arms in the battle against HIV.