that we did not really understand that during the early phases of hiv when patients appear to be a sim attic that the levels of virus in the blood are causing inflammation and affecting their organs. by treating people early we can prevent the damage to these organs. the second reason we weren't treating all individuals is because early on the drugs had side effects so what we thought would be the best strategy to wait until people progressed in their disease to a point where the benefits of treatment out weighed the risk. everything has changed now and now we know at all stages of hiv disease the virus is more toxic than medications. therefore we should start treatment immediately and for this reason in 2010 our clinic at san francisco general hospital served by the department of public health put forward a policy of treatment of all individuals for therapy of living with hiv. we had a community forum. it was highly controversial. it was fevered in the -- featured in the "new york times" and other cities followed suit. the current u.s. guidelines now recommend treatment for all individuals