Brazil, a middle-income country, has provided free and universal access to HAART since 1996 but is grappling with the rising cost of AIDS treatment. In Brazil, HAART is recommended to symptomatic HIV-positive patients regardless of viral load counts and to asymptomatic patients with CD4þT cell counts below 200/mm3. HAART is considered for asymptomatic patients with CD4þ cell counts between 200/ mm3 and 350/mm3; decisions to start treatment are determined on a case-by-case basis. The total number of patients receiving HAART has increased each year since 1997, with a reported 180,000 of the estimated 600,000 HIV-infected Brazilians receiving treatment in 2006 (Figure 1) (AIDS Care and Treatment Department of the National STD and AIDS Program of Brazil, personal communication) [3]. Over this period, mother-to-child transmission of HIV declined; AIDSrelated hospitalizations, mortality, and morbidity declined; and life expectancy of AIDS patients more than tripled from an estimated 18 to 58 months [4–10]. Estimated AIDS incidence has plateaued, particularly in southeastern Brazil, the region with highest HIV prevalence [9,11]. Nonetheless, the number of patients receiving HAART is likely to increase as Brazil continues to expand treatment and patients live longer.