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Drug cocktails have become so effective that a 20-year-old person with HIV-AIDS in a wealthy country such as Canada can now expect to live another 43 years on average - close to a normal lifespan, according to new research.

"If you can get drugs, you can now lead a relatively normal life," Anton Pozniak, executive director of HIV research at the Chelsea and Westminster Hospital in London, told the XVII International AIDS Conference in Mexico City.

Antiretrovirals (ARVs), which came into use about a decade ago, are not only effective at keeping the disease in check, they are now much easier to take, less toxic and with fewer side effects.

Today, patients require as little as one pill a day, compared to complex 30-pill-a-day regimes only a few years ago, Dr. Pozniak said.

Clinicians have become so adept at using ARVs that they can keep the level of virus circulating in the body to undetectable levels, making their patients essentially non-infectious, which could be a key element in stemming the epidemic, he added.

But the near-miraculous effects of antiretroviral drugs only serve to underscore the need to treat as many people as possible, and not merely those in the developed world, Dr. Pozniak told the conference.

There are about 33 million people worldwide infected with HIV-AIDS, according to UNAIDS.

About three million people in the developing world are being treated with antiretroviral drugs, an estimated 31 per cent of those who could benefit. About as many people again with HIV-AIDS are taking the drug cocktails in the developed world, where treatment is virtually universal.

"I ran out of fingers and toes to count the inequalities," Dr. Pozniak said.

The world, via a United Nations resolution, has vowed to make ARVs available to all patients who need them by 2010, but that target seems unlikely to be met.

Greg Gonsalves, program co-ordinator at the AIDS and Rights Alliance for Southern Africa, said that it is nonetheless essential to keep trying.

"The scale-up of antiretroviral therapy is the most ambitious public-health undertaking of our lifetimes," he said.

Mr. Gonsalves said the lives of millions of people depend on making ARVs universally available, but the world should have no illusions about how difficult that will be.

"We've already accomplished the impossible in the last 10 years," he said. "We can succeed, but our future is precarious. The technical challenges are formidable, and the political ones are brutal."

One of the most contentious debates at the international conference revolves around the question of when it is best to start treatment of people infected with HIV-AIDS.

Currently, patients tend to begin treatment with ARVs when their CD4 count falls below 200. (CD4 cells control the body's immune response against infections and are a key measure of how the disease is progressing.) But under the new guidelines, published by the International AIDS Society earlier this week, it is recommended that anyone with a CD4 count of 350 or lower begin treatment with ARVs.

While that may be relatively easy to do in the developed world, it would dramatically increase the number of people requiring treatment in the developing world and costs would skyrocket.

Currently, it costs about $2.7-billion a year to treat three million patients with ARVs.