The concept of an unchanging absolute of best clinical practice is intrinsically erroneous; the impression of such an ideal being static is illusory—this is never more evident than in the rapidly evolving field of HIV clinical management. As new clinical data are reported, the kaleidoscope shifts and different treatment patterns emerge. In this issue we examine the evidence behind the most recent strategies for salvage therapy in those patients at greatest risk of disease progression despite extensive prior antiretroviral exposure. Also, Suzanne Mitchell discusses the most important issues currently facing clinicians in the management of CMV retinitis.