Better, but not good enough More than 33 million people are infected with HIV worldwide.1 Over the past 30 years, mortality from HIV and the life expectancy of people who are infected have improved dramatically. With major advances in biomedical research, increased awareness, and dedicated funding, HIV has been transformed from an untreatable and almost always fatal disease to a chronic one. For patients diagnosed promptly and treated with combination antiretroviral therapy (ART), life expectancy is now several decades.2 In the linked cohort study (doi:10.1136/bmj.d6016), May and colleagues estimate specific life expectancy for people in the United Kingdom with HIV undergoing treatment compared with life expectancy in the general population.3 Gains in life expectancy have increased steadily over time, with the availability of more effective and better tolerated regimens. But these gains have not been seen in everyone with HIV. Factors associated with worse outcomes include late presentation to healthcare services, suboptimal adherence to drugs, premature discontinuation of treatment, mental illness, and behavioural risk factors such as use of injected drugs and alcohol dependence.4 Data from the …