There is hardly any other medical field that has experienced changes and developments as dramatic as in the treatment of HIV infection in the last years. In Germany, 19 antiretroviral substances have been approved. New substances are effective in multidrug resistance viruses. The classes of CCR5 receptor antagonists and integrase inhibitors are new therapeutic options for heavily pretreated patients. In spite of this success many problems remain unsolved, e.g., lipodystrophy, osteoporosis, cardiovascular diseases and an increased number of tumors. Once more, the ideal point of treatment initiation needs to be discussed. Treating early prevents new infections and improves the course of HIV infection.