Antiretroviral therapy has saved countless lives. However, we know it to be imperfect and we are always looking for ways to improve outcomes. For treatment-naïve patients, it is time either to optimise the dose of efavirenz, or replace it altogether with integrase inhibitors in combination with two nucleosides. For people requiring a second-line treatment, new studies have confirmed the current WHO standard of care but also indicated a novel approach of two new classes of drug therapy in combination, as a public health approach without the need for resistance testing. This brings us to early treatment, which is now simple, non-toxic and beneficial in reducing transmission, but about which there has been controversy in the context of insufficient resources to cover the existing number of people needing treatment.